Malnutrition In Chronic Kidney Disease Patients Research Articles

Analysis of malnutrition factors for inpatients with chronic kidney disease.

Malnutrition is a common complication of Chronic Kidney Disease (CKD), and it is the risk factor of CKD prognosis. This study aim to evaluate the nutritional status of inpatients with CKD by using the Subjective Global Assessment (SGA), and to analyze the related factors of malnutrition; and to provide effective reference for early detection of malnutrition status in patients with CKD and timely nutrition intervention. A total of 426 patients (238 male patients, 188 female patients) aged 62.62 ± 14.61 and 61.14 ± 14.82, respectively admitted to the Nephrology Department of Wannan Medical College from February 2020 to December 2020 were selected and included in to this study by convenience sampling. 426 patients with CKD were evaluated by SGA. Human body weight, hemoglobin (Hb), total protein (TP), albumin (ALB), pre-albumin (PA), qualitative analysis of urinary protein and other laboratory indexes were collected and measured. The correlation between malnutrition and age, education, gender, diet, CKD stage and other factors was analyzed by spearman correlation analysis. The incidence of malnutrition was 85.7% among 426 patients with CKD. Gender, age, education level, CKD stage, diabetes mellitus, weight loss and reduced food intake were related to SGA nutritional assessment (P < 0.05). The expression levels of ALB, PA and Hb in the malnutrition group were significantly lower than those in the normal group (P < 0.05). The degree of malnutrition in CKD patients was significant negatively correlated with the expression levels of ALB (r = -0.188), PA (r = -0.262) and Hb (r = -0.176) (P < 0.05). The multivariate Logistic regression analysis model showed that female (OR = 2.155), ≥60 years old (OR = 7.671), weight loss (OR = 10.691), reduced food intake (OR = 28.953), moderate and severe serum ALB expression (OR = 3.391 and 8.326) were risk factors for malnutrition in patients with CKD (P < 0.05). Malnutrition was correlated with the results of qualitative examination of urinary protein (r = 0.268, P < 0.05). Gender, age, weight loss, reduced food intake, serum ALB expression were independently associated with malnutrition in patients with chronic kidney disease, Hence, the medical staff should take timely and effective nutrition intervention for the patients with malnutrition, delay the renal function damage of patients with CKD and improve the quality of life of patients. Inpatients with CKD, especially women, should increase their dietary intake, maintain normal weight and improve their nutritional status.

Prevalence and Management Recommendations for Disease-Related Malnutrition in Chronic Kidney Disease Patients with and without Diabetes.

To investigate the nutritional risk, malnutrition, severe malnutrition, and malnutrition prevalence of different stages in chronic kidney disease (CKD) patients with and without diabetes mellitus using the Global Leadership Initiative on Malnutrition (GLIM), and to analyze the causes of malnutrition and to improve the clinical outcomes of patients for early intervention. A total of 683 patients with CKD who were hospitalized in our hospital from January 2020 to January 2021 were enrolled and divided into subgroups 1 to 5 according to whether they were complicated with diabetes and glomerular filtration rate. Using the second step of the malnutrition (GLIM) diagnostic tool and 2 previously commonly used malnutrition assessment methods (body mass index <18.5 kg/m2 with poor general condition, 3 points for nutritional deficiency in nutritional risk screening), combined with clinical research on the main causes of malnutrition, the intervention measures were discussed. The prevalence of malnutrition was 16.7% (114/683) in the patients included in the survey using the diagnostic criteria of malnutrition (GLIM) (excluding whole body muscle mass index). The prevalence of malnutrition in CKD patients with and without diabetes was 23.7% and 12.6%, respectively. The overall prevalence rate of severe malnutrition was 14.2%, and the prevalence rates of those with and without diabetes were 19.0% and 11.4%, respectively; the results of the two methods of malnutrition assessment showed that the prevalence of malnutrition in CKD patients with diabetes was higher than that in the uncombined group. There was no severe malnutrition in patients with CKD stages 1 and 2. From CKD stage 3 onwards, the severe malnutrition in the diabetic group was significantly higher than that in the uncombined group. With the progression of CKD, the incidence of malnutrition also gradually increased, indicating that malnutrition is related to primary diseases and concomitant diseases. Attention should be paid to the malnutrition of CKD patients with diabetes, and clinical medical staff need to pay early attention to various diseases that lead to the progression of CKD, such as diabetes, primary nephropathy, and other factors, to prevent complications and delay the progression of CKD.

In Patients with Chronic Kidney Disease Advanced Glycation End-Products Receptors Isoforms (sRAGE and esRAGE) Are Associated with Malnutrition.

Background: in patients with chronic kidney disease (CKD), the inflammatory and pro-oxidant milieu may contribute to malnutrition development. In this study, we investigated the relationship between inflammation, advanced glycation end-products (AGEs), and their receptors (RAGEs) with malnutrition in CKD patients. Methods: we evaluated 117 patients. AGEs were quantified by fluorescence intensity using a fluorescence spectrophotometer, soluble RAGEs isoforms, and inflammatory interleukins by ELISA. Malnutrition was assessed by a malnutrition inflammation score. Results: mean age was 80 ± +11 years, eGFR was 25 ± +11 mL/min/1.73 m2 and BMI was 28 ± 5 Kg/m2. Malnourished individuals were older, had lower estimated protein intake (nPCR 0.65 ± 0.2 vs. 0.8 ± 0.2 vs. 0.8 ± 0.3, p = 0.01), higher C reactive protein (CRP 0.6 ± 1 vs. 0.6 ± 0.7 vs. 0.17 ± 0.13, p = 0.02) and tumor necrosis factor α (TNF α 14.7 ± 8.7 vs. 15.6 ± 8 vs. 11.8 ± 5.8, p = 0.029). Malnourished patients had higher sRAGE (2813 ± 1477 vs. 2158 ± 1236 vs. 2314 ± 1115, p = 0.035) and esRAGE (648 [408–1049] vs. 476 [355–680] vs. 545 [380–730] p = 0.033). In the multivariate analysis, only sRAGE maintained its association with malnutrition (p = 0.02) independently of aging and inflammation. Conclusions: in CKD patients, RAGEs isoforms, but not AGEs, are associated with malnutrition, irrespective of systemic inflammation, aging, and renal function.

POS-262 LOW-PROTEIN DIETS IN CHRONIC KIDNEY DISEASE – SAFE OR NOT? A SINGLE LARGE CENTER EXPERIENCE

Recent studies emphasized the role of low-protein diets (LPDs) in the management of chronic kidney disease (CKD) in order to postpone renal replacement therapy. However, the risk of malnutrition in CKD patients on LPDs has often been debated. We present the results of a large single-center, focusing on the safety of LPDs in both diabetic and non-diabetic patients with CKD. A prospective, randomized, controlled study with 207 non-diabetic patients with CKD stage 4+ were grouped by the type of nutritional intervention - vegetarian very low protein diet with 0.3g/kg-day supplemented with ketoanalogues of essential aminoacids (sVLPD) versus LPD with 0.6g/kg-day for 15 months. We present the safety parameters at the end of study (EOS), but also after 10 years of follow-up. Safety data from a second interventional study, including 97 diabetic patients with stage 4+ CKD who received LPD supplemented with ketoanalogues of essential aminoacids (sLPD) for 12 months are also presented. Subjective Global Assessment (SGA), clinical data (Body Mass Index, BMI), and biochemical parameters (serum albumin, C-reactive protein) were analyzed. Patients’ adherence to the type of nutritional intervention was assessed by the estimated protein intake using urinary urea excretion. Both protein and energy intake were also evaluated through food diary. Nutritional status of non-diabetic patients was preserved for both sVLPD and LPD at 15 months after inclusion (SGA A 84 versus 85%, p=0.83). Moreover, the subjects continued the nutritional intervention after the EOS. After 10 years of nutritional intervention, the kidney’s survival (86 versus 46%, p<0.0001) and patients’ survival (89 versus 60%, p<0.0001) were much better in the sVLPD group. The levels of serum albumin were constantly around 4 g/dL, without any significant differences between groups at all study moments. The C-reactive protein levels were lower in patients on sVLPD at 15 months after inclusion (4 versus 5 mg/L, p<0.0001), respectively at 10 years after inclusion (5 versus 10 mg/L, p<0.0001). Patients’ adherence was confirmed at all study moments. For diabetic patients, during the study, there were improvements in body weight (BMI 27.1 versus 26.0 kg/m², p<0.0001), serum albumin (3.9 to 4.1 g/dL, p<0.0001), and in C-reactive protein levels (14 to 9 mg/L, p<0.0001). All patients had SGA A throughout the study. Nutritional intervention with different low-protein regimens seem to be safe for patients with CKD, both in diabetics and in non-diabetics.

MO609PREVALENCE OF MALNUTRITION AND INFLAMMATION IN NONDIALYZED PATIENTS WITH CHRONIC KIDNEY DISEASE: A CLINICAL STUDY

Abstract Background and Aims The prevalence of chronic kidney disease (CKD) in India varies from 0.16–0.78%. The reported incidence of malnutrition in CKD patients is 37–84%. There is a paucity of data on the quantification of malnutrition and inflammation in undialyzed patients of CKD from north east of India. This study analyzed the prevalence and causes of malnutrition and inflammation in patients with CKD before the initiation of dialysis treatment. Method This study was conducted from May 2017 to May 2019 in the department of nephrology Guahati medical college hospital. Assessment of nutritional and inflammatory status was carried out in patients with CKD before initiation of dialysis. Serum albumin; body mass index (BMI); triceps skin fold thickness (TST); mid-arm muscle circumference (MAMC); and subjective global assessment (SGA) scoring were used for assessment of nutritional parameters. Serum C-reactive protein; serum albumin and serum ferritin level were used to assess the inflammatory status in these patients. Results A total of 528 (male:female= 359:169) patients with CKD participated in this study. Diabetic Nephropathy (35%) was the most common; followed by; hypertension (23%) and chronic glomerulonephritis (20 %). The evidence of malnutrition was noted in 344 (65%). The mean age of patients with malnutrition was 52.8±12.45 years with a male predominance (68%). On the basis of SGA score; malnutrition was noted in 344 patients (mild moderate [36%]; severe; [30%]); remaining (34%) were well nourished. Thus; evidence of Malnutrition was noted in 65% of patients with CKD.). Serum total protein &amp; albumin were higher in the non-malnourished patients in comparison to malnourished (5.83±1.0 vs 5.31±1.12 p&amp;lt;0.05; 3.65±0.7 vs 2.62±0.74) The inflammatory markers (serum ferritin &amp; C reactive protein) were elevated significantly in patients with malnutrition in comparison to those without malnutrition (308.15±60.18 mg/dL vs. 251.64±63.14 mg/dL; p &amp;lt; 0.001; 77% vs. 50%; p &amp;lt; 0.01). Conclusion Malnutrition and inflammation are common in patients with CKD before the commencement of dialysis. This indicates that an emphasis should be placed on the assessment and prevention or correction of malnutrition and inflammatory burden in these patients with CKD.

Ameliorating Chronic Kidney Disease Using a Whole Food Plant-Based Diet.

Novel approaches to ameliorating chronic kidney disease (CKD) are warranted as most patients are undiagnosed until they begin displaying symptoms of kidney failure. There is increasing evidence that a whole food plant-based (WFPB) diet may offer benefits that slow the progression of CKD, decrease the incidence cardiovascular disease, decrease rates of diabetes and obesity, and reduce inflammation and cholesterol, which in turn can delay kidney failure and the initiation of dialysis. While animal-based protein ingestion promotes an acidic environment, inflammation and renal hyperfiltration, study authors report plant-based protein can be alkaline-producing and anti-inflammatory and can contain renoprotective properties. Although there may be benefits to adopting a WFPB diet, macronutrient and micronutrient content should be carefully considered and adjusted to avoid malnutrition in CKD patients. Further research needs to be done in order to establish the biological plausibility and feasibility of a WFPB in individuals with diagnosed CKD.

THE CORRELATION BETWEEN HS-CRP LEVEL AND NUTRITION STATUS TO THE QUALITY OF LIFE OF PATIENTS WITH CHRONIC KIDNEY DISEASE WHO UNDERWENT HEMODIALYSIS IN HAJI ADAM MALIK CENTRAL GENERAL HOSPITAL MEDAN

Chronic kidney disease (CKD) is a global health problem with global prevalence ranging from 11-13%. The process of chronic inflammation and malnutrition in CKD patients undergoing hemodialysis (HD) is a medical condition that affects the quality of life. This study aims to determine the correlation of hs-CRP levels and nutritional status with quality life of CKD patients undergoing HD. This research is an analytical study, cross sectional design, conducted in December 2019 - March 2020 at Haji Adam Malik General Hospital Medan. Based on the fisher's exact test of 37 samples, a significant correlation was found between hs-CRP and physical health (p = 0. 037, PR 1.6) and with psychological well- being (p = 0.045; PR 1.78). There was no correlation found between hs-CRP with social relations (p = 0.091; PR 1.7) and the environment (p = 0.078; PR 1.54). A significant correlation was found between nutritional status and several domains including physical health (p = 0.038; PR 1.6), psychological well-being (p = 0.005; PR 2.09), social correlations (p = 0.011; PR 2.48), and the environment (p = 0.012; PR 2.02). The study determinded that there was correlation found between hs-CRP levels with physical health and psychological well-being and between nutritional status with all domains of quality of life.

Evaluation of Nutrition Risk Screening Score 2002 (NRS) assessment in hospitalized chronic kidney disease patient.

BackgroundAlthough chronic kidney disease (CKD) patients are particularly prone to malnutrition, systematic nutritional screening is rarely routinely performed during hospitalization. The primary aim of this study was to determine the prevalence of malnutrition (as captured by the nutritional screening score NRS) in hospitalized CKD patients and explore the impact of malnutrition on hospital mortality.MethodsAll patients admitted to the tertiary nephrology department of the University hospital of Bern Inselspital over a period of 12 months were included in this observational study. The risk for malnutrition was assessed within 24h of admission by the NRS. Demographic, clinical, and outcome data were extracted from the patient database. The primary outcome was in-hospital mortality. The secondary outcomes were length of hospitalization and hospitalization costs. Multilevel mixed-effect logistic regression model analysis was performed to determine the association of in-hospital mortality and risk of malnutrition (NRS score≥3).ResultsWe included 696 eligible hospitalizations of 489 CKD patients. Hospitalized patients had a median age of 64 years (interquartile range (IQR), 52–72), 35.6% were at risk of malnutrition (NRS≥3). After adjustment for the identified confounders (Case weight, Barthel index, and CKD stage) multivariate analysis confirmed an independent and significant association between higher in-hospital mortality with NRS≥3 [OR 2.92 (95% CI: 1.33–6.39), P<0.001]. Furthermore, in multivariate analysis the risk of malnutrition was associated with longer length of hospitalization [Geometric mean ratio: 1.8 (95% CI: 1.5–2.0), p<0.001] and with increased hospitalization costs [Geometric mean ratio: 1.7 (95% CI: 1.5–1.9), p<0.001]).ConclusionsMalnutrition in CKD patients, as captured by NRS>3, is highly prevalent among hospitalized CKD patient and associated with prolonged hospital stay and increased in-hospital mortality.

Avaliação Nutricional de Pacientes com Doença Renal Crônica em Hemodiálise

Introdução: a Desnutrição Proteico-Energética (DPE) é muito comum em pacientes com doença renal crônica (DRC), principalmente entre aqueles que fazem hemodiálise, e está associada ao aumento da morbidade e mortalidade dessa população. A prevalência de DPE pode variar de acordo com o método diagnóstico utilizado. Objetivo: identificar, por meio de revisão de literatura, os métodos de avaliação nutricional comumente utilizados e a prevalência de desnutrição em pacientes com DRC em tratamento por hemodiálise. Métodos: foi realizada por meio de levantamento bibliográfico de artigos científicos publicados de 2005 à 2015. A combinação dos seguintes descritores foi utilizada: “doença renal crônica”, “avaliação nutricional” e “desnutrição”, nos idiomas português e inglês. Resultados: Foram selecionados 14 artigos após aplicação dos critérios de exclusão. Métodos antropométricos e níveis séricos de albumina pos‑ suem limitações devido à alteração na composição corporal do doente renal crônico. Métodos subjetivos parecem ser mais eficazes na identificação de DPE. Recentemente a ISRMN (International Society of Renal Nutrition and Metabolism) propôs novos critérios diagnósticos de DPE em pacientes com DRC baseados em medidas bioquímicas, de massa corporal, de massa magra e de ingestão alimentar. Considerações finais: Os critérios propostos pela ISRMN parecem ser promissores, mas são necessários novos estudos para a sua validação.

Preventive Strategies for Vascular Calcification in Patients with Chronic Kidney Disease.

Vascular calcification is significant because of the close association between the degree of vascular calcification and cardiovascular mortality in chronic kidney disease (CKD) patients. There are 2 types of vascular calcification in CKD patients. One is endothelial vascular calcification, a common type of vascular calcification. Another is medial vascular calcification, a specific type that is common in CKD patients. The former is mainly associated with atherosclerosis due to hyperlipidemia, especially hypercholesterolemia. The latter CKD-specific type is called Moenckeberg's arteriosclerosis. A known risk factor for this type of vascular calcification is hyperphosphatemia. In this review article, we mainly discuss a preventive strategy for Moenckeberg type vascular calcification in CKD, primarily involving the treatment of hyperphosphatemia. Several possible modalities are considered. However, at present, dietary restriction of phosphate is not recommended so as to avoid malnutrition in CKD patients. The first consideration is the enhancement of phosphate removal by renal replacement therapy in dialysis patients. Various phosphate binder therapies can be beneficial and effective. Surgical and pharmacological parathyroidectomies are also useful for treating secondary hyperparathyroidism. Good quality bone provides a good pool of calcium and phosphate. Thus, bone protection is another option for preventing vascular calcification. Several therapeutic agents have been developed to manage osteoporosis. These trial agents may be reasonably effective in impeding the progression of vascular calcification in CKD patients. Key Messages: We should make full use of several modalities so as to completely prevent vascular calcification.