Effects of dietary intake and nutritional status on cerebral oxygenation in patients with chronic kidney disease not undergoing dialysis: A cross-sectional study.

Susumu Ookawara,Keiji Hirai,Miho Murakoshi,Yoshio Kaku,Mitsutoshi Shindo,Kanako Kizukuri,Yoshiyuki Morishita,Kiyonori Ito,Taro Hoshino,Kaoru Tabei,Michiko Shiina,Mayako Miyahara,Saori Minato,Haruhisa Miyazawa,Nagisa Inose,Yuko Horiuchi,Aiko Namikawa,Shinobu Nakahara,Tatsuo Shimosawa

doi:10.1371/journal.pone.0223605

Susumu Ookawara, Keiji Hirai + Show 17 more

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https://doi.org/10.1371/journal.pone.0223605

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Abstract

Dietary management is highly important for the maintenance of renal function in patients with chronic kidney disease (CKD). Cerebral oxygen saturation (rSO2) was reportedly associated with the estimated glomerular filtration rate (eGFR) and cognitive function. However, data concerning the association between cerebral rSO2 and dietary intake of CKD patients is limited. This was a single-center observational study. We recruited 67 CKD patients not undergoing dialysis. Cerebral rSO2 was monitored using the INVOS 5100c oxygen saturation monitor. Energy intake was evaluated by dietitians based on 3-day meal records. Daily protein and salt intakes were calculated from 24-h urine collection. Multivariable regression analysis showed that cerebral rSO2 was independently associated with energy intake (standardized coefficient: 0.370) and serum albumin concentration (standardized coefficient: 0.236) in Model 1 using parameters with p < 0.10 in simple linear regression analysis (body mass index, Hb level, serum albumin concentration, salt and energy intake) and confounding factors (eGFR, serum sodium concentration, protein intake), and the energy/salt index (standardized coefficient: 0.343) and Hb level (standardized coefficient: 0.284) in Model 2 using energy/protein index as indicated by energy intake/protein intake and energy/salt index by energy intake/salt intake in place of salt, protein and energy intake. Cerebral rSO2 is affected by energy intake, energy/salt index, serum albumin concentration and Hb level. Sufficient energy intake and adequate salt restriction is important to prevent deterioration of cerebral oxygenation, which might contribute to the maintenance of cognitive function in addition to the prevention of renal dysfunction in CKD patients.

Highlights

Diet therapy, including the energy intake management and protein and salt restriction, is a key aspect of chronic kidney disease (CKD) therapy and makes an important contribution to the maintenance of renal function
Multivariable regression analysis showed that cerebral rSO2 was independently associated with energy intake and serum albumin concentration in Model 1 using parameters with p < 0.10 in simple linear regression analysis and confounding factors, and the energy/salt index and Hb level in Model 2 using energy/protein index as indicated by energy intake/ protein intake and energy/salt index by energy intake/salt intake in place of salt, protein and energy intake
Cerebral rSO2 is affected by energy intake, energy/salt index, serum albumin concentration and Hb level

Summary

Introduction

Diet therapy, including the energy intake management and protein and salt restriction, is a key aspect of chronic kidney disease (CKD) therapy and makes an important contribution to the maintenance of renal function. Near-infrared spectroscopy (NIRS) has been used as a tool to measure the regional saturation of oxygen (rSO2), a marker of tissue oxygenation, in order to clarify the influence of CKD progression on cerebral oxygenation in CKD patients receiving hemodialysis (HD) [13,14,15,16,17]. The results of these measurements reflect the status of cognitive impairment because of the relationship of rSO2 with the Mini-Mental State Examination scores [16] and the Montreal Cognitive Assessment test [17]. Data concerning the association between cerebral rSO2 and dietary intake of CKD patients is limited

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