Nutrition In Dialysis Patients Research Articles

Nephrology nurses' views in giving a dietary recommendation for dialysis patients: An interview study.

Nutrition in dialysis patients plays an essential role in their life. Diet in dialysis patients are catered individually and applied according to the situation of the patients. A dietary recommendation is vital to dialysis patients, and nephrology nurses help patients understand the reasoning behind the dietary restrictions enforced. This paper aimed to explore nephrology nurses' views in giving dietary recommendations for dialysis patients. In this descriptive qualitative study, one focus group discussion (n = eight nurses) and four individual interviews in one Renal Centre in Brunei Darussalam was conducted through purposive sampling. This interview took place between October 2020 and December 2020. Three major themes were identified: (1) Approaches in giving dietary information, (2) Getting patients to follow a diet plan, and (3) Negotiating with patients. The importance of nephrology nurses in improving patient care, particularly in providing dietary recommendations to dialysis patients, cannot be overstated. They adopted different approaches, including negotiating with patients and using available resources to ensure that patients followed the dietary recommendations. However, they believe their current method and strategy for offering dietary recommendations to dialysis patients could be improved.

Assessment of Malnutrition Inflammation Score in Different Stages of Chronic Kidney Disease.

Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD), and is associated with high morbidity and mortality. Malnutrition-Inflammation Score (MIS) has significant correlations with prospective hospitalization and mortality, as well as measures of anemia, inflammation, and nutrition in dialysis patients. The study was conducted on 100 adult patients of CKD selected from K&D clinic PGIMS, Rohtak. All the patients went under detailed socioeconomic, clinical, biochemical and radiological examination. The average of three measurements of body weight, height, triceps skin fold thickness (TST), and mid-arm muscle circumference (MAMC) were measured in all patients. MIS was calculated for all the patients. Out of total 100 patients, 64 were male and 36 were female. Overall, the prevalence of malnutrition was 60%. A total of 42%, 16% and 2% patients had mild, moderate and severe malnutrition respectively. Our study also shows significant association between staging of CKD (3 to 5-D) and MIS. A significant negative correlation was found between MIS and factors such as BMI, eGFR, serum calcium and hemoglobin levels. A significant positive correlation of this score was found with blood urea serum creatinine, serum uric acid, serum potassium and serum phosphate. Multivariate analysis showed significant association between MIS and serum albumin, TIBC, BMI, family income and hs-CRP. Assessment of key components of malnutrition and inflammation early in disease course will help to identify high risk subjects in whom modifying these predictors will help in providing active and healthy life for CKD patients.

Nutrition in dialysis patients

Nutrition in dialysis patients

Historical Study (1986-2014): Improvements in Nutritional Status of Dialysis Patients

Malnutrition is common in dialysis patients and is associated with adverse clinical outcomes. Despite an increased focus on improved nutrition in dialysis patients, it is claimed that the prevalence of malnutrition in this group of patients has not changed during the last decades. Direct historical comparisons of the nutritional status of dialysis patients have never been published. To directly compare the nutritional status of past and current dialysis patients, we implemented the methodology of a study from 1986 on a population of dialysis patients in2014. Historical study comparing results of two cross-sectional studies performed in 1986 and2014. We compared the nutritional status of hemodialysis (HD) and peritoneal dialysis (PD) patients attending the dialysis center at Roskilde Hospital, Denmark, in February to June 2014, with that of HD and PD patients treated at the dialysis center at Fredericia Hospital, Denmark, in April1986. Maintenance PD and HD patients (n=64 in 2014 and n=48 in 1986). We performed anthropometry (body weight, triceps skinfold, and midarm muscle circumferences [MAMCs]) and determined plasma transferrin. Relative body weight, triceps skinfold, MAMC, body mass index, and prevalence of protein-caloric malnutrition as defined in the original study from1986. Average relative body weight, triceps skinfold, MAMC, and body mass index were significantly higher in 2014 compared with 1986. The prevalence of protein-caloric malnutrition was significantly lower in 2014 (18%) compared with 1986 (52%). The nutritional status of maintenance dialysis patients has improved during the last 3decades. The reason for this improvement could not be identified in the present study, but the most likely contributors are the higher prevalence of obesity in the general population, less predialytic malnutrition, and an improved focus on nutrition in maintenance dialysis patients.

Ernährungstherapie bei Mangelernährung – Ein unverändert relevantes Thema in der Nephrologie

Der Ernährung kommt im Gesamtkonzept der Behandlung von Niereninsuffizienten und Dialysepatienten eine zentrale Rolle zu. Wichtiges Ziel in der Ernährungsberatung ist es, dem Patienten und seinen Bezugspersonen Hilfestellung zur Lösung der individuellen Diätprobleme anzubieten. Als Parameter zur Beurteilung des Ernährungszustandes bei Dialysepatienten dienen vor allem ein Gewichtsverlust sowie ein niedriger Serumalbumin– und Cholesterinwert. Bei Patienten mit einer glomerulären Filtrationsrate von unter 20 ml/min sollte der Eiweiß– und Energiestatus regelmäßig erfasst werden. Idealerweise sollte die Ernährungstherapie im Team durchgeführt werden. Das Team sollte aus dem behandelnden Arzt, dem Nephrologen, der Ernährungsfachkraft, dem Pflegepersonal sowie den pflegenden Angehörigen bestehen.

Predictors of serum creatinine in haemodialysis patients: a cross-sectional analysis.

C-reactive protein (CRP) levels, an acute phase response index, predict cardiovascular outcome and are inversely related to visceral proteins, including albuminaemia in haemodialysis patients. Less definite is the relationship between inflammation and markers of somatic proteins such as serum creatinine in such patients. To explore these questions, a cross-sectional analysis of potential predictors of serum creatinine was performed. One hundred and seventy-nine prevalent haemodialysis patients as of June 2001 were included in the cohort. Midweek pre-dialysis blood samples were collected during the months of June, September through to December 2001 inclusive, and determinations of serum urea (urease method), creatinine (alkaline picrate method) and CRP levels by means of a high sensitivity immunonephelometric method were performed. Furthermore, pre- and post-dialysis body weights were recorded and 2 min post-dialysis serum urea levels were determined three times. They were utilized for the calculation of single pool Kt/V and of normalized protein catabolic rate (nPCR). Each of the data represents the mean of three determinations made every 3 months in the study period. The analysis of multivariate linear regression was able to validate our model characterized by a dependent variable, serum creatinine and four independent variables (age, CRP, Kt/V and nPCR) (R(2)=0.60; F=24.10; P<0.00001; SE=1.94). Age (-0.08 mg/dl decrease in serum creatinine per 1-year increase in age), Kt/V (-0.25 mg/dl decrease in serum creatinine per 0.1 increase in Kt/V) and nPCR (0.10 mg/dl increase in serum creatinine per 0.1 g protein/kg/day increase in nPCR) were independently predictive of serum creatinine (P<0.00001). CRP and dialysis vintage did not predict serum creatinine. Stratifying the patients for the effects of CRP, only CRP values </=4 mg/l were directly predictive of serum creatinine (P<0.00001), whereas CRP values >4 mg/l were not. A further insight was given by the stratification of the patients for the effects of the interquartile ranges of CRP: it showed a progressive and statistically significant reduction of beta-coefficient inversely related to the increasing CRP values (P=0.003). Thus, the nature of the correlation between CRP and serum creatinine changes with increasing CRP values: from being a direct one, it shows a trend towards a transformation into an indirect one with beta=0 at a CRP value of approximately 9 mg/l. However, this indirect relationship does not reach statistical significance. The present cross-sectional study suggests that the activation of acute phase response does not influence creatinine metabolism in haemodialysis patients; in contrast, age, Kt/V and nPCR predict serum creatinine levels. Larger prospective trials are needed to achieve a definitive answer about the relationship between somatic proteins, acute phase response activation and nutrition in dialysis patients.

Interactions Between Hemodialysis Adequacy and Nutrition in Dialysis Patients

Seminars in DialysisVolume 12, Issue 2 p. 112-116 CARDIAC DISEASE IN DIALYSIS PATIENTS Interactions Between Hemodialysis Adequacy and Nutrition in Dialysis Patients Eduardo K. Lacson Jr., Eduardo K. Lacson Jr. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, with support from the National Kidney Foundation of Singapore, SingaporeSearch for more papers by this authorWilliam F. Owen Jr., William F. Owen Jr. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, with support from the National Kidney Foundation of Singapore, SingaporeSearch for more papers by this author Eduardo K. Lacson Jr., Eduardo K. Lacson Jr. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, with support from the National Kidney Foundation of Singapore, SingaporeSearch for more papers by this authorWilliam F. Owen Jr., William F. Owen Jr. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, with support from the National Kidney Foundation of Singapore, SingaporeSearch for more papers by this author First published: 05 January 2002 https://doi.org/10.1046/j.1525-139X.1999.00001.xCitations: 3 William F. Owen Jr. MD Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume12, Issue2April 1999Pages 112-116 RelatedInformation

Creatinine kinetic modelling: a simple and reliable tool for the assessment of protein nutritional status in haemodialysis patients

While the mathematical modelling of urea kinetics is in wide use for evaluating treatment adequacy and protein nutrition in dialysis patients, the kinetics of creatinine generation in dialysis patients has been relatively unexplored. In this study creatinine kinetic modelling as a clinical tool was investigated in a group of 90 patients treated by haemodialysis (n = 20), haemodiafiltration (60), haemofiltration (7), or biofiltration (3) over a 6-36-month period. A single pool model of creatinine kinetics was employed to obtain monthly values of creatinine distribution space and creatinine appearance rate. Extrarenal creatinine degradation rate, estimated using a clearance of 0.038 l/kg/24 h as suggested by Mitch and co-workers, was added to creatinine appearance rate in urine and dialysate to calculate a corrected creatinine index (CI). Extrarenal degradation accounted for 12 +/- 2% of CI. CI was higher in males (22.4 +/- 4.5 mg/kg/24 h) than females (19.8 +/- 4.8) and decreased with age, falling off more sharply for the female group (CI = 29.9-0.185.age, R = 0.72) than the males (CI = 24.1-0.030.age, R = 0.31). CI was found to correlate strongly with protein catabolic rate determined by urea kinetic modelling (CI = 8.84 +/- 10.91.PCR). Low or reduced CI was associated in this study group with severe malnutrition status and high mortality rate. CI is suggested as a strong predictor of patient morbidity and mortality.

Metabolic acidosis and nutrition in dialysis patients.

The renal elimination of nonvolatile acids, mainly formed by oxidation of sulfuric amino acids, is about 70 mmol/day. In hemodialysis (HD) patients who cannot eliminate an excess of H+ via the kidneys, the accumulation of H+ in the interdialytic period results in progressive depletion of the bicarbonate buffer stores, which are repleted by the dialysis procedure. Metabolic acidosis is common in HD patients, since dialytic repletion of the bicarbonate stores is often far from complete; acidosis seems to be less common in CAPD patients, who are continuously provided with lactate from the dialysis fluid as a buffer source. Experimental and clinical studies have shown that metabolic acidosis induces negative nitrogen balance, increased muscle protein degradation and increased oxidation of the branched-chain amino acids (valine, leucine, isoleucine). Acidosis is the only uremic toxic factor identified which stimulates protein catabolism. Correction of metabolic acidosis in HD patients normalizes low muscle intracellular concentrations of the branched-chain amino acids and reduces signs of renal osteodystrophy. The long-term influence of correction of acidosis on nutritional status, morbidity and mortality needs to be assessed in prospective studies.

Subjective global assessment of nutrition in dialysis patients

Malnutrition is a major negative prognostic factor in dialysis patients. Simple and reliable estimations of nutritional status may therefore prove of particular value in the follow-up of these patients. To validate subjective global assessment (SGA) in dialysis patients we compared subjective global assessment with objective measurements (anthropometry, bioelectrical impedance, biochemical measurements) in 59 chronic uraemic patients treated by haemodialysis (n = 36) or CAPD (n = 23). Subjective global assessment was performed by an observer unaware of the results of objective measurements and was related to serum albumin (r = -0.51, P < 0.001) and bioelectric impedance phase angle (r = -0.58, P < 0.001) as well as with MAMC (r = -0.28 P = 0.028), %fat (r = -0.27, P = 0.042) and nPCR (r = -0.29 P = 0.027). Multiple regression analysis showed that the relationship of subjective global assessment (as a dependent variable) with objective measurements (covariates) was stronger (multiple r = 0.77) than the relationship found with univariate analysis. This finding indicates that subjective global assessment gives a well-based and balanced estimation of nutritional status. Our data show that subjective global assessment is a clinically adequate method for assessing nutritional status in dialysis patients. Being an inexpensive method of well-proven reliability, subjective global assessment can be recommended for a more frequent assessment of nutritional status in dialysis patients.

Importance of Nutrition in Dialysis Patients

Importance of Nutrition in Dialysis Patients