Nutritional Status In Maintenance Hemodialysis Patients Research Articles

Evaluation of the relationship between dietary energy and protein intakes and anthropometric measurements in hemodialysis patients.

This study evaluated the relationship between dietary energy, and protein (animal and plant based) intakes and anthropometric measurements in maintenance hemodialysis (MHD) patients. Individuals between the ages of 19 to 65 who received MHD treatment for more than 3 months from October 2021 to February 2022 in the state hospitals were included in the study. Body mass index (BMI) (kg/m2) was calculated for each patient, and anthropometric measurements including upper middle arm circumference, triceps skinfold thickness (TST) and hand grip strength (HGS) were carried out. 3-day food records and Subjective Global Assessment (SGA) were used to assess nutritional status of the patients. Of the 51 MHD patients included in the study, 33 (64.7%) were male and 18 (35.3%) were female. The mean age of the patients was 50.37 ± 11.55 years, and length of time on MHD was 39.49 ± 51.68 months. The mean energy intake of female and male MHD patients was 20.01 ± 6.94 and 17.26 ± 6.24 kcal/kg/d, respectively. The mean dietary protein intake of female and male MHD patients were 0.84 ± 0.35 and 0.78 ± 0.30 g/kg/d, respectively. Dry weight (P = .048), BMI (P = .020), TST (P = .013), and HGS (P = .026) of well-nourished and moderately malnourished female MHD patients according to SGA results were found to be lower than in male patients. While the majority of the patients receiving MHD treatment appeared to be well-nourished according to the SGA results, energy and protein intakes obtained from the food records were below the recommended daily dietary intake. These evaluations affected the anthropometric measurements including HGS, BMI, and TST. Therefore, there is a need for more comprehensive clinical studies in which anthropometric measurements, food consumption, biochemical findings and nutritional screening tools are used all together to evaluate nutritional status in MHD patients.

Effect of HMB on Phase Angle of Maintenance Hemodialysis Patients

Objective To observe and evaluate the effect of β- hydroxy-β- methylbutyric acid (HMB) on phase angle (PA) in maintenance hemodialysis (MHD) patients. Methods From March 2018 to August 2019, 64 patients who received maintenance hemodialysis, at Chengdu Fifth People's Hospital, were selected as subjects, and they were divided into experimental group and control group with single center, random, single dose, single blind control design, and 32 patients in each group. HMB intervention was performed in the trial group and placebo in the control group for 12 weeks. Human component analysis (Inbody S770) was performed before and after intervention in the two groups to observe the change of phase angle. Scored Patient-Generated Subjective Global Assessment (SGA) and Malnutrition Inflammatory Score (MIS) were used to assess the nutritional status of MHD patients before and after group entry, to observe the correlation of its numerical change and the phase angle. Results The PA, SGA, MIS of the experimental group was significantly higher (p<0.05) than that of the control group (p<0.05), and the test group increased better than the control group (p<0.05). Positive correlation between PA and SGA, MIS (p<0.05). Conclusions By giving patients complementary HMB, to improve patient nutritional status, to improve the patient phase angle, and improve the patient prognosis.

Application of bioelectrical impedance analysis in nutritional assessment of patients with hemodialysis

Objective To explore the effect and related influencing factors of body composition measurement based on bioelectrical impedance analysis(BIA)in evaluating the nutritional status of patients with maintenance hemodialysis(MHD). Methods A total of 54 patients with MHD were selected as research objects. The nutritional status of MHD patients was evaluated by BIA, anthropometric indexes and laboratory indexes. The related influencing factors of skeletal muscle loss in MHD patients were analyzed by multiple linear regression analysis. Results The results of BIA showed that the incidence of skeletal muscle deficiency was 40.74%, and the detection rate was high. Pearson correlation analysis showed that skeletal muscle was significantly correlated with body mass index, high-density lipoprotein, transferrin, serum phosphorus, body cell volume, bone mineral content, basic metabolism, upper arm muscle circumference, upper arm circumference, body fat percentage, protein and inorganic salt(P<0.05). Multiple linear regression analysis showed that serum phosphorus and protein were the influencing factors of skeletal muscle(P<0.05). Conclusion The incidence of malnutrition in MHD patients is high, and the problem of skeletal muscle reduction is prominent. Serum phosphorus and protein levels are the influencing factors of skeletal muscle content in MHD patients. It is necessary to strengthen the control of serum phosphorus level in patients with MHD in order to slow down the process of skeletal muscle atrophy. BIA technology combined with laboratory index detection is recommended for comprehensive evaluation and regular follow-up of nutritional status of MHD patients.

Application of patient participation-based diet management in maintenance hemodialysis patients

Objective To explore the effects of patient participation-based diet management on nutritional status among maintenance hemodialysis (MHD) patients. Methods From January 2015 to December 2017, we selected 140 MHD patients at Beijing Friendship Hospital of Capital Medical University as subjects by convenience sampling. All of the patients were divided into experimental group and control group with the method of random number table, 70 cases in each group. Control group carried out general diet guidance for MHD patients, while experimental group provided the participation-based diet management involving making the diet management booklet and the diet plan together. The body mass index (BMI) , plasma albumin (ALB) , pre-albumin (PAB) of patients between two groups were evaluated and patients' nutritional status was assessed with the patient-generated subjective global assessment (PG-SGA) one day before discharge, six weeks and 12 weeks after intervention. Results There were interaction effects of groups, time, groups and time in ALB, PAB and scores of PG-SGA between two groups with statistical differences (P<0.01) . Six weeks and 12 weeks after intervention, the levels of ALB and PAB of experimental group were higher than those of control group, and the scores of PG-SGA were lower than that of control group; the differences were statistical (P<0.01) . Conclusions Patient participation-based diet management can improve nutritional status of MHD patients. Key words: Dialysis; Patient participation; Diet therapy; Nutritional status

MON-142 Cross-sectional study of nutritional status in Chinese maintenance hemodialysis patients

Protein-energy malnutrition are common in maintenance hemodialysis (MHD) patients and are associated with increased morbidity and mortality. To evaluate the nutritional status of Chinese MHD patients, we performed a cross-sectional study in unselected patients treated with hemodialysis thrice weekly. The subjects were MHD patients in our outpatient hemodialysis center. The physical measurement, laboratory values and three-day food diaries were collected. Body composition was measured by bioelectrical impedance analysis (BIA). Global nutritional status was evaluated by the modified quantitative subjective global assessment (MQSGA). 159 MHD patients (males 83, females 76, mean age 64.09±13.55 years, mean dialysis age 46.83±53.65 months) were enrolled. The mean body mass index (BMI) was 21.42±3.01kg/m2 in men and 20.35±2.73kg/m2 in women. The upper arm muscle circumference (23.72±2.75cm in men, 22.52±2.78cm in women) and hand-grip strength (26.23±9.61 in men, 17.16±7.76 in women) were lower than normal population standard values. By using BIA, the body fat mass percent (17.89±7.98 in men, 24.06±6.90 in women) was within the standard range of the normal population, but the body muscle mass percent (77.71±8.51 in men, 71.17±7.36 in women) was lower than the standard range of the normal population. Both the calorie intake (27.66±11.99kcal/kg) and protein intake (1.11±0.42g/kg) were lower than the K/DOQI guideline recommendation. The dietary sodium intake (2935.75±1495.50mg) was higher than K/DOQI guideline recommendation and the dietary phosphorus intake (903.25±300.38mg) was within the range of the K/DOQI guideline recommendation. The mean levels of serum albumin, serum phosphate and serum calcium were 39.34±3.12g/l, 1.76±0.62mmol/l and 2.35±0.26mmol/l, respectively. The mean level of MQSGA was 11.34±2.43. The total nutritional status of MHD patients in our hemodialysis center were not bad, except for body muscle mass and hand-grip strength. Despite the lower dietary calorie and protein intake, the nutritional status and normal serum phosphate level were maintained, which suggested the amount of dietary calorie and protein intake for Chinese MHD patients needs to be further investigated.

Effect of Zinc Supplementation on Maintenance Hemodialysis Patients: A Systematic Review and Meta-Analysis of 15 Randomized Controlled Trials.

We aimed to examine the effects of zinc supplementation on nutritional status, lipid profile, and antioxidant and anti-inflammatory therapies in maintenance hemodialysis (MHD) patients. We performed a systematic review and meta-analysis of randomized, controlled clinical trials of zinc supplementation. Metaregression analyses were utilized to determine the cause of discrepancy. Begg and Egger tests were performed to assess publication bias. Subgroup analysis was utilized to investigate the effects of zinc supplementation in certain conditions. In the crude pooled results, we found that zinc supplementation resulted in higher serum zinc levels (weighted mean difference [WMD] = 28.489; P < 0.001), higher dietary protein intake (WMD = 8.012; P < 0.001), higher superoxide dismutase levels (WMD = 357.568; P = 0.001), and lower levels of C-reactive protein (WMD = −8.618; P = 0.015) and malondialdehyde (WMD = −1.275; P < 0.001). The results showed no differences in lipid profile. In the metaregression analysis, we found that serum zinc levels correlated positively with intervention time (β = 0.272; P = 0.042) and varied greatly by ethnicity (P = 0.023). Results from Begg and Egger tests showed that there was no significant bias in our meta-analysis (P > 0.1). Results of subgroup analysis supported the above results. Our analysis shows that zinc supplementation may benefit the nutritional status of MHD patients and show a time-effect relationship.

Effect of protein-energy malnutrition on erythropoietin requirement in maintenance hemodialysis patients

Possible interactions between inflammatory and nutritional markers and their impact on recombinant human erythropoietin (rHuEPO) hyporesponsiveness are not well understood. We investigated the role of nutritional status in rHuEPO requirement in maintenance hemodialysis (MHD) patients without evidence of inflammation. This cross-sectional study included 88 MHD patients. The associations between required rHuEPO dose and malnutrition-inflammation score (MIS) and several laboratory values known to be related to nutrition and/or inflammation were analyzed. Anthropometric measures including body mass index, triceps skinfold thickness, and midarm circumferences were also measured. Twenty-three patients with serum C-reactive protein levels >10 mg/L were excluded from the analysis. The remaining 65 patients (male/female, 41/24; age 49.1+/-11.4 years; dialysis duration 99.7+/-63.0 months) were studied. These patients had moderate malnutrition and the average MIS was 7.4 (range 3-17). The average weekly dose of administered rHuEPO was 69.1+/-63.1 U/kg. Malnutrition-inflammation score had a positive correlation with the serum concentration of tumor necrosis factor-alpha, whereas it had a negative correlation with anthropometric measures, total iron-binding capacity, prealbumin, phosphorus, creatinine, and triglyceride. According to Pearson's correlation analysis, significant relationships of increased MIS with increased required rHuEPO dose and rHuEPO responsiveness index (EPO divided by hematocrit) were observed (p=0.008, r=-0.326; p=0.017, r=-0.306, respectively). Recombinant human erythropoietin dose requirement is correlated with MIS and adverse nutritional status in MHD patients without evidence of inflammation. Further research should focus on reversing the undergoing microinflammation for a better outcome in dialysis patients.

Dogma and the Renal Patient

Nutrition care of the patient with renal disease is relatively complex, given the significant number of potential metabolic derangements seen in this population. Many clinicians describe a high level of uncertainty regarding care for patients with either acute or chronic renal failure. Professionals attempting to care for these patients should be able to turn to the medical literature for guidance in making rational, appropriate decisions regarding this care. Unfortunately, the nephrology literature is rife with articles purporting to represent evidence-based recommendations, when in fact the conclusions made are the opinion of the author(s). The initial fault in the nephrology literature is a lack of controlled trials of significant size and design to allow for conclusions regarding patient care to be drawn. This deficiency was most apparent in the publication of the Kidney Disease Outcomes Quality Initiative (K/DOQI) by the National Kidney Foundation. This initiative represented an exhaustive review of the nephrology literature in a number of areas of care of the renal patient, including nutrition. However, the result of this review was both a dearth of evidence-based guidelines and the repeated request for more research to be performed. The K/DOQI guidelines for nutrition, for example, contained 22 of 27 guidelines that were, at least in part, opinion based. Given the lack of a literature basis for evidencebased nephrologic practice, authors of review articles will have a tendency to pursue 1 of 2 approaches. One approach results in the presentation of as complete a description of the disease process as possible, with a rational approach to evaluation or treatment offered as an option. The alternative is a presentation fostering a specific opinion as the only interpretation, regardless of the evidence or lack thereof. In this issue of Nutrition in Clinical Practice, we provide an overview of issues and controversies associated with provision of nutrition support to patients with acute and chronic renal failure. An expert panel of authors provides the reader with information pertinent to everyday care of these complex patients. There is still so much that we don’t know about the impact of our nutrition interventions on outcomes in acute renal failure (ARF). We know that nutritional status is an important prognostic indicator in maintenance hemodialysis (MHD), but we still don’t have the definitive standards to determine nutritional status. It’s time to reevaluate the paradigms now entrenched in practice. Is albumin the definitive marker of nutritional status in MHD patients? Is intradialytic parenteral nutrition (IDPN) safer and more effective than enteral nutrition, or are we treating a clinician bias against enteral feeding? What is the optimum protein intake for ARF, and do we need to consider specific amino acids as being essential for these very sick patients? Finally, is carnitine deficiency widespread in this population, or can these patients synthesize adequate amounts?

Evaluation of body composition and nitrogen content of renal patients on chronic dialysis as determined by total body neutron activation

Total body protein (nitrogen), body cell mass (potassium), fat, and water were measured in 15 renal patients on maintenance hemodialysis (MHD). Total body nitrogen was measured by means of prompt γ neutron activation analysis; total body water was determined with tritium labeled water; total body potassium was measured by whole body counting. The extracellular water was determined by a technique utilizing the measurement of total body chloride and plasma chloride. When compared with corresponding values of a control group of the same age, sex, and height, the protein content, body cell mass, and total body fat of the MHD patients were within the normal range. The only significant change was an increase in the extracellular water/body cell mass ratio in the male MHD patients compared to the controls. The lack of significant difference of the nitrogen values of the MHD patients compared to matched controls suggests that dialysis minimizes any residual effects of uremic toxicity or protein-calorie malnutrition. These findings further suggest that there is a need to reevaluate the traditional anthropometric and biochemical standards of nutritional status for MHD patients. It was concluded that it is particularly important to measure protein stores of MHD patients with low protein intake to ascertain nutritional status. Finally, in vivo measurement of total body nitrogen and potassium for determination of body composition provides a simple, direct, and accurate assessment of the nutritional status of MHD patients.