1
|
da Silva AT, Machado RP, Martins ML, Dorneles LEG, Dalmarco EM, da Silva EL, Hinnig PDF, Wazlawik E. Whey Protein, Vitamins C and E Decrease Interleukin-10 in Chronic Hemodialysis Patients: A Pioneer, Randomized, Double-Blind Pilot Trial. J Ren Nutr 2024; 34:58-67. [PMID: 37598813 DOI: 10.1053/j.jrn.2023.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE To evaluate the effects of supplementation with whey protein combined with vitamins C and E on inflammatory markers in hemodialysis (HD) patients. DESIGN AND METHODS This was a pioneer, randomized and double-blinded study. Patients were randomized into two groups and stratified by HD frequency. The supplementation group received 20 g of whey protein, 250 mg of vitamin C, and 600 IU of vitamin E; the placebo group, 20 g of rice flour, and microcrystalline cellulose capsules. The interventions were given after HD, 3 times a week, for 8 weeks. The inflammatory markers were assessed: interleukin (IL) IL-12p70, IL-10, IL-6, IL-8, and tumor necrosis factor alpha. For statistical analysis, the χ2 test, Student's t-test, Mann-Whitney test, analysis of variance for repeated two-way measurements, paired t test, and Wilcoxon test were performed. P < .05 was considered statistically significant. RESULTS Twenty-three patients completed the study. No significant differences were found in inflammatory markers when comparing the groups postintervention. In the intragroup was a decrease in IL-10 in the supplementation group after 8 weeks (P = .0382). IL-6 tended to decrease by 810.95% in the supplementation group and increased by 732.8% (nonsignificant) in the placebo group. CONCLUSION Whey protein combined with vitamins C and E significantly reduced IL-10 in the supplementation group and could be beneficial to reduce IL-6 in HD patients. Future studies are suggested with a larger sample size, different supplementation doses, and longer interventions.
Collapse
Affiliation(s)
- Angela Teodósio da Silva
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Roberta Pieri Machado
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Mayara Lopes Martins
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | | | - Edson Luiz da Silva
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Patrícia de Fragas Hinnig
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Elisabeth Wazlawik
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| |
Collapse
|
2
|
Lambie M, Davies S. An update on absolute and relative indications for dialysis treatment modalities. Clin Kidney J 2023; 16:i39-i47. [PMID: 37711635 PMCID: PMC10497377 DOI: 10.1093/ckj/sfad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 09/16/2023] Open
Abstract
Background Choosing a dialysis modality is an important decision for people to make as their kidney failure progresses. In doing so, their options should be informed by any absolute or relative indications that may favour one modality over another. Methods In creating this update, we reviewed literature using a framework that considered first, high-level outcomes (survival and modality transition) from large registry data and cohort studies when considering optimal patient pathways; second, factors at a dialysis provider level that might affect relative indications; and third, specific patient-level factors. Both main types of dialysis modality, peritoneal (PD) and haemodialysis (HD), and their subtypes were considered. Results For most people starting dialysis, survival is independent of modality, including those with diabetes. Better survival is seen in those with less comorbidity starting with PD or home HD, reflecting continued improvements over recent decades that have been greater than improvements seen for centre HD. There are provider-level differences in the perceived relative indications for home dialysis that appear to reflect variability in experience, prejudice, enthusiasm, and support for patients and carers. Absolute contraindications are uncommon and, in most cases, where modality prejudice exists, e.g. obesity, Adult Polycystic Kidney Disease, and social factors, this is not supported by reported outcomes. Conclusion Absolute contraindications to a particular dialysis modality are rare. Relative indications for or against particular modalities should be considered but are rarely more important than patient preferences.
Collapse
Affiliation(s)
- Mark Lambie
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, UK
| | - Simon Davies
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, UK
| |
Collapse
|
3
|
Hoppe K, Schwermer K, Kawka A, Klysz P, Baum E, Kaluzna M, Sikorska D, Scigacz A, Lindholm B, Pawlaczyk K, Oko A. Dialysis vintage stratified comparison of body composition, hydration and nutritional state in peritoneal dialysis and hemodialysis patients. Arch Med Sci 2018; 14:807-817. [PMID: 30002698 PMCID: PMC6040140 DOI: 10.5114/aoms.2016.61902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/17/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Body mass decomposition and hydration state imbalances affect patients on maintenance dialysis. We compared body composition, hydration and nutritional state of patients on peritoneal dialysis (PD) and hemodialysis (HD) based on dialysis vintage (DV). MATERIAL AND METHODS Three hundred and fifty-nine prevalent patients on HD (n = 301) and PD (n = 58) were divided into 3 subgroups depending on DV: < 2 years HD (n = 41) and PD (n = 28), 2-4 years HD (n = 111) and PD (n = 17), > 4 years HD (n = 149) and PD (n = 13). Bioimpedance analysis delivered data including overhydration (OH), Lean (LTM) and adipose lipids mass (FAT). Other measurements included daily diuresis (DD), subjective global assessment (SGA) and serum albumin (alb), C-reactive protein (CRP) and total cholesterol (TChol), and hemoglobin (Hb). RESULTS Dialysis vintage < 2 years. Hemodialysis patients were older (65.5 ±18.5 vs. 50.9 ±17.1; p < 0.01) with a higher mortality (28 vs. 1; p < 0.01) and OH (8.0 ±4.3 vs. 1.6 ±3.1; p < 0.001). Hemoglobin (10.6 ±1.5 vs. 11.8 ±1.7; p < 0.05), TChol (180.2 ±47.0 vs. 211.7 ±46.3; p < 0.05), DD (871 ±729 vs. 1695 ±960; p < 0.001) and LTM (46.5 ±12.9 vs. 53.8 ±14.4; p < 0.05) were lower on HD. Dialysis vintage 2-4 years: when compared to PD, HD patients had higher OH (11.7 ±5.9 vs. 2.1 ±3.2; p < 0.001) and lower Hb (10.8 ±1.5 vs. 11.9 ±1.4; p < 0.01). Dialysis vintage > 4 years: compared to PD, HD patients had higher LTM (44.3 ±11.7 vs. 38.6 ±7.9; p < 0.05) and lower FAT (34.4 ±11.1 vs. 42.8 ±6.4; p < 0.01). CONCLUSIONS Dialysis patients' body composition depends on dialysis modality and DV. Dialysis vintage < 2 years is associated with better hydration, nutritional state, and survival in PD patients, but longer DV reduces these benefits. Dialysis vintage > 4 years associated with similar hydration and mortality in both PD and HD while body composition was better on HD.
Collapse
Affiliation(s)
- Krzysztof Hoppe
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Schwermer
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Kawka
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Patrycja Klysz
- Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Baum
- Department of Philosophy and Bioethics, Poznan University of Medical Sciences, Poznan, Poland
| | - Malgorzata Kaluzna
- Department of Endocrinology, Metabolic Disorders and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Dorota Sikorska
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Scigacz
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Bengt Lindholm
- Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
- Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Andrzej Oko
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
4
|
Unraveling the relationship between mortality, hyponatremia, inflammation and malnutrition in hemodialysis patients: results from the international MONDO initiative. Eur J Clin Nutr 2016; 70:779-84. [DOI: 10.1038/ejcn.2016.49] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/23/2016] [Accepted: 02/17/2016] [Indexed: 12/12/2022]
|
5
|
Yavuz S, Cetinkaya S, Anarat A, Bayazıt AK. Apelin and nutritional status in children on dialysis. Ren Fail 2014; 36:1233-8. [DOI: 10.3109/0886022x.2014.937661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
6
|
Abbas SR, Liu L, Sipahioglu MH, Rosales L, Carter M, Kotanko P, Levin NW, Zhu F. Comparison of Bioimpedance Techniques to Detect Changes in Fluid Status in Hemodialysis Patients. Blood Purif 2014; 37:48-56. [DOI: 10.1159/000356830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022]
|
7
|
CHUA HORNGRUEY, XIANG LING, CHOW PEKYEE, XU HUI, SHEN LIANG, LEE EVAN, TEO BOONWEE. Quantifying acute changes in volume and nutritional status during haemodialysis using bioimpedance analysis. Nephrology (Carlton) 2012; 17:695-702. [DOI: 10.1111/j.1440-1797.2012.01653.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
Lacquaniti A, Bolignano D, Donato V, Chirico V, Romeo A, Loddo S, Buemi M. Obestatin: a new element for mineral metabolism and inflammation in patients on hemodialysis. Kidney Blood Press Res 2011; 34:104-10. [PMID: 21282963 DOI: 10.1159/000324034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 12/31/2010] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Obestatin plays a key role in the process of energy balance maintenance with an anorectic effect. The main aim of the study was to evaluate obestatin in uremic patients to determine whether it is correlated with nutritional and inflammatory status. METHODS We studied plasma obestatin in uremic patients (n = 50) undergoing hemodialysis therapy and in healthy subjects. Plasma obestatin was measured using an ELISA kit. RESULTS Obestatin levels in uremic patients were lower than in healthy subjects (p < 0.0001). Patients with a body mass index (BMI) >23 had lower obestatin levels than those with a BMI <23 (p = 0.001). After multivariate analysis, direct correlations were maintained between obestatin and high-sensitivity C-reactive protein (β = 0.68, p < 0.0001) and total alkaline phosphatases (β = 0.30, p = 0.03), while inverse correlations were found with iron (β = -0.32, p = 0.002) and calcium-phosphorous product (β = -0.40, p = 0.001). CONCLUSIONS Based on the present observational data, obestatin might be implicated in the inflammatory state and the disturbances of calcium/phosphate metabolism of hemodialysis patients. However, further studies are warranted to determine whether this hormone plays a key role in contributing to malnutrition and to the chronic inflammatory process.
Collapse
|
9
|
Demirci MS, Demirci C, Ozdogan O, Kircelli F, Akcicek F, Basci A, Ok E, Ozkahya M. Relations between malnutrition-inflammation-atherosclerosis and volume status. The usefulness of bioimpedance analysis in peritoneal dialysis patients. Nephrol Dial Transplant 2010; 26:1708-16. [DOI: 10.1093/ndt/gfq588] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
|
10
|
Tsai AC, Lu SJ, Chang TL. Modified Mininutritional Assessment Can Effectively Assess the Nutritional Status of Patients on Hemodialysis. J Ren Nutr 2009; 19:380-8. [DOI: 10.1053/j.jrn.2008.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Indexed: 11/11/2022] Open
|
11
|
Bogónez-Franco P, Nescolarde L, Bragós R, Rosell-Ferrer J, Yandiola I. Measurement errors in multifrequency bioelectrical impedance analyzers with and without impedance electrode mismatch. Physiol Meas 2009; 30:573-87. [PMID: 19491458 DOI: 10.1088/0967-3334/30/7/004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study is to compare measurement errors in two commercially available multi-frequency bioimpedance analyzers, a Xitron 4000B and an ImpediMed SFB7, including electrode impedance mismatch. The comparison was made using resistive electrical models and in ten human volunteers. We used three different electrical models simulating three different body segments: the right-side, leg and thorax. In the electrical models, we tested the effect of the capacitive coupling of the patient to ground and the skin-electrode impedance mismatch. Results showed that both sets of equipment are optimized for right-side measurements and for moderate skin-electrode impedance mismatch. In right-side measurements with mismatch electrode, 4000B is more accurate than SFB7. When an electrode impedance mismatch was simulated, errors increased in both bioimpedance analyzers and the effect of the mismatch in the voltage detection leads was greater than that in current injection leads. For segments with lower impedance as the leg and thorax, SFB7 is more accurate than 4000B and also shows less dependence on electrode mismatch. In both devices, impedance measurements were not significantly affected (p > 0.05) by the capacitive coupling to ground.
Collapse
Affiliation(s)
- P Bogónez-Franco
- Electronic Engineering Department, Technical University of Catalonia (UPC), Jordi Girona 1-3 Edifici C4, 08034 Barcelona, Spain.
| | | | | | | | | |
Collapse
|
12
|
Carter M, Zhu F, Kotanko P, Kuhlmann M, Ramirez L, Heymsfield SB, Handelman G, Levin NW. Assessment of body composition in dialysis patients by arm bioimpedance compared to MRI and 40K measurements. Blood Purif 2009; 27:330-7. [PMID: 19270452 DOI: 10.1159/000207200] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 11/04/2008] [Indexed: 01/21/2023]
Abstract
This study used multi-frequency bioimpedance spectroscopy (BIS) of the arm and whole body to estimate muscle mass (MM) and subcutaneous adipose tissue (SAT) in 31 hemodialysis (HD) patients comparing these results with magnetic resonance imaging (MRI) and body potassium ((40)K) as gold standards. Total body and arm MM (MM(MRI)) and SAT (SAT(MRI)) were measured by MRI. All measurements were made before dialysis treatment. Regression models with the arm (aBIS) and whole body (wBIS) resistances were established. Correlations between gold standards and the BIS model were high for the arm SAT (r(2) = 0.93, standard error of estimate (SEE) = 3.6 kg), and whole body SAT (r(2) = 0.92, SEE = 3.5 kg), and for arm MM (r(2) = 0.84, SEE = 2.28 kg) and whole body MM (r(2) = 0.86, SEE = 2.28 kg). Total body MM and SAT can be accurately predicted by arm BIS models with advantages of convenience and portability, and it should be useful to assess nutritional status in HD patients.
Collapse
Affiliation(s)
- M Carter
- Renal Research Institute, Yorkville Dialysis Center, 1555 3rd Avenue #218, New York, NY 10128, USA
| | | | | | | | | | | | | | | |
Collapse
|