Recent Advances in the Nutritional Screening, Assessment, and Treatment of Japanese Patients on Hemodialysis

Combined Prognostic Value of Preprocedural Protein-Energy Wasting and Inflammation Status for Amputation and/or Mortality after Lower-Extremity Revascularization in Hemodialysis Patients with Peripheral Arterial Disease

Protein-energy wasting is associated with inflammation and advanced atherosclerosis in hemodialysis patients. We enrolled 800 patients who had undergone successful lower-extremity revascularization, and we investigated the association among the Geriatric Nutritional Risk Index (GNRI) as a surrogate marker of protein-energy wasting, C-reactive protein (CRP), and their joint roles in predicting amputation and mortality. They were divided into lower, middle, and upper tertiles (T1, T2, and T3) according to GNRI and CRP levels, respectively. Regarding the results, the amputation-free survival rates over 8 years were 47.0%, 56.9%, and 69.5% in T1, T2, and T3 of the GNRI and 65.8%, 58.7%, and 33.2% for T1, T2, and T3 of CRP, respectively (p < 0.0001 for both). A reduced GNRI [adjusted hazard ratio (aHR) 1.78, 95% confidence interval (CI) 1.24-2.59, p = 0.0016 for T1 vs. T3] and elevated CRP (aHR 1.86, 95% CI 1.30-2.70, p = 0.0007 for T3 vs. T1) independently predicted amputation and/or mortality. When the two variables were combined, the risk was 3.77-fold higher (95% CI 1.97-7.69, p < 0.0001) in patients who occupied both T1 of the GNRI and T3 of CRP than in those who occupied both T3 of the GNRI and T1 of CRP. In conclusion, patients with preprocedurally decreased GNRI and elevated CRP levels frequently experienced amputation and mortality, and a combination of these two variables could more accurately stratify the risk.

Multicenter Study to Validate a Hospitalization Risk Assessment Tool in Hemodialysis Patients

Introduction Protein-energy wasting is a prevalent condition in patients with chronic kidney disease. Our goal was to validate the risk assessment tool (Hashmi's tool) in multiple centers, developed in 2018, as it was easily applicable and cost-effective. Methods The following variables were scored as 0, 1, 2, or 3 as per severity: body mass index, HD vintage in years, functional capacity, serum albumin, serum ferritin, and the number of co-morbid conditions (diabetes mellitus, hypertension, ischemic heart disease, and cerebrovascular disease). This scoring system was applied to maintenance hemodialysis patients in six different centers. The patient's record was evaluated for two years. Patients were divided into low-risk (score <6) and high-risk (score ≥6). We compared the two groups using the chi-square test for the difference in hospitalization and mortality. Results A total of 868 patients' records were analyzed, and the maximum score was 13 with the application of Hashmi's tool. Four hundred twenty-nine patients were in the low-risk group, and 439 patients fell into the high-risk group. Four hundred sixty-seven patients were male, and 401 were females; 84% had hypertension, and 54% had diabetes mellitus. In the high-risk group, we identified more females. Patients' likelihood of being in the high-risk group was higher if they had diabetes mellitus, hypertension, or ischemic heart disease. Hospitalization due to vascular or non-vascular etiologies was more common in the high-risk group (p=0.036 and p<0.001, respectively). A total of 123 patients died during the study period, 92 from the high-risk group as compared to 31 from the low-risk group. This was three times higher and statistically significant (p<0.001). Conclusion Using a simple and cost-effective tool, we have identified malnourished patients who are at risk of hospitalization and mortality. This study has validated the previous work at a single center, which has now been reflected in six dialysis units across Saudi Arabia.

Comparison of the effect of hemodialysis and peritoneal dialysis in the treatment of end-stage renal disease

Objective

To compare the clinical effects of hemodialysis (HD) and peritoneal dialysis (PD) in the treatment of end-stage renal disease (ESRD) patients.

Methods

Clinical data of ESRD patients who received HD (n=74) and PD (n=77) for more than 12 months in the First People's Hospital of Tonglu County from October 2020 to November 2021 were retrospectively selected. Renal function indexes, blood pressure, and complication rates in the two groups before the first dialysis and at the end of the observation period were compared.

Results

After the dialysis, the urea nitrogen (BUN) levels decreased in both groups, and were significantly lower in the PD group compared to the HD group. Urea clearance index (Kt/V) increased, and were significantly higher in the PD group compared to the HD group (P<0.05). After the dialysis, albumin (ALB) and cardiac ejection fraction (EF) levels significantly increased, and ALB levels were significantly higher in the HD group while EF levels were significantly higher in the PD group (P<0.05). Levels of whole parathyroid hormone (iPTH), systolic blood pressure, and diastolic blood pressure indicators in both groups decreased compared to before the dialysis, and were significantly lower in the PD group compared to the HD group of patients (P<0.05). PD was associated with significantly lower total incidence of complications compared to HD (P<0.05).

Conclusions

Peritoneal dialysis is more effective in maintaining the hemodynamic stability for ESRD patients, reducing blood pressure level, improving the clearance rate of molecular substances, and protecting the renal function of patients compared to hemodialysis.