Nutritional Status Of Hemodialysis Patients Research Articles

Elemental Concentrations in Scalp Hair, Nutritional Status and Health‐Related Quality of Life in Hemodialysis Patients

Elemental concentrations in hair from hemodialysis (HD) patients have not been well investigated. We examined the relationships between the elemental concentrations in scalp hair and health-related quality of life (HRQOL) and nutritional status in HD patients. Twenty six elemental concentrations were measured in scalp hair samples from 60 male HD patients using inductively-coupled plasma mass spectrometry. To evaluate HRQOL, the Short Form 36 item health survey (SF36) was used. As indices of nutritional status, body mass index, serum parameters, and geriatric nutritional risk index (GNRI) were used. Phosphorus correlated positively with serum creatinine, blood urea nitrogen (BUN), GNRI and the physical domains of the SF36. Zinc correlated positively with serum creatinine, BUN and the physical domains of the SF36. Mercury and arsenic correlated positively with BUN. Cadmium correlated negatively with serum albumin, BUN and GNRI. Copper correlated positively with the physical domains of the SF36. Iodine correlated negatively with the physical domains of the SF36. Selenium correlated negatively with the mental domains of the SF36. In conclusion, phosphorus and zinc concentrations in scalp hair can be additional biomarkers of HRQOL and/or nutritional status in HD patients. Cadmium accumulation correlated with malnutrition. Iodine and selenium accumulation may adversely affect HRQOL. Further investigation is necessary to determine precisely how these elements affect these measures.

Nutritional Status of Hemodialysis Patients in a Developing Economy: A Case Study in Nigeria

An important indicator of the well-being of any individual is the status of his/her nutrition. Apart from being a notable pointer of quality of life, nutrition is an inevitable agent for sustainable well-being of all individuals. This paper examined the nutritional status of hemodialysis patients before and after dialysis. The study was based on primary and secondary data. A purposive sampling procedure was adopted to administer structured questionnaires on 20 patients with chronic renal failure, under going dialysis at the Renal Unit of the Male and Female Medical Wards (South West 3 and North West 3 and Owena renal Wards) University College Hospital, Ibadan Oyo State, Nigeria. The reliability of the research instrument was conducted using test-retest method and this gave a reliability coef ficient of (r) = 0.82. Data collected were analyzed using simple percentage distribution, mean with their standard deviations and the cross tabulation of key variables were performed. The study revealed that nutritional status of the patients has serious impacts on the prognosis of the disease. Also, clinical symptoms such as nausea, vomiting, diarrhea, and oedema were common among the subjects. The study, however, recommends that the public should be enlightened on the causes of renal failure, healthy eating- habit. It also calls on government to subsidize the cost of health care for the patients under going hemodialysis. Dieticians were also sensitized to improve the energy and micronutrient intake of patients under going maintenance hemodialysis.

Interdialytic Weight Gain Does Not Influence the Nutrition of New Hemodialysis Patients

The aim of the present study was to assess the relationship between interdialytic weight gain (IDWG) and nutrition markers in hemodialysis (HD) patients, by means of repeated measures analysis. The records of 255 patients, who had recently received conventional HD for a minimum of 1 year, were retrospectively reviewed. Nutrition markers, including serum albumin, serum phosphate, blood urea nitrogen, and creatinine, were recorded at monthly intervals and subjected to repeated measures analysis. Patients with higher IDWG/dry weight (IDWG%) (>5%) had significantly lower body mass index throughout the study. Repeated measures analysis of variance indicated no significant difference in these nutrition markers for patients with different IDWG%. At the end of the study, neither IDWG nor IDWG% were found to be associated with albumin or phosphate, on linear regression analysis. There was no evidence of better nutrition in new HD patients with higher IDWG%. Although increased intake is promoted as critical for improving nutritional status in HD patients, it may be inappropriate to focus solely on the benefits of higher IDWG%, which can also lead to the development of hypertension, left ventricular hypertrophy, and intradialytic hypotension.

The Association between Serum Adiponectin Levels and Nutritional Status of Hemodialysis Patients

Adiponectin plays an important role in the regulation of body weight, insulin sensitivity, lipid metabolism, and the inflammatory response. Adiponectin is elevated in hemodialysis patients. We investigated the association between altered serum adiponectin levels and the nutritional–inflammation status of hemodialysis patients. Forty-four hemodialysis patients (21 men and 23 women; mean age 53.9 ± 9.2 years) were enrolled and 32 healthy volunteers were included as the control group. Serum adiponectin was measured using a commercial radioimmunoassay kit. Serum albumin, cholesterol, triglyceride, high-sensitivity C-reactive protein, urea, creatinine, transferrin, lean body mass, fat mass, body mass index (BMI), the subjective global assessment (SGA) score, and the malnutrition–inflammation score (MIS) were measured in all patients. Adiponectin levels were significantly elevated in the hemodialysis patients compared with the healthy subjects (24.8 ± 10.4 μg/mL and 6.8 ± 4.2 μg/mL, respectively, p < 0.0001). Serum adiponectin correlated positively with SGA (r = 0.47) and MIS (r = 0.38), and negatively with BMI (r = −0.34), triglyceride (r = −0.53), and glucose levels (r = −0.42). Serum adiponectin levels were significantly higher in malnourished patients than in well-nourished patients when assessed with SGA (20.5 ± 10.4 μg/mL and 29.0 ± 8.7 μg/mL, respectively, p = 0.005). In conclusion, serum adiponectin levels reflect the nutritional–inflammation status of hemodialysis patients. Adiponectin may also be associated with insulin resistance, dyslipidemia, and the inflammatory response in these patients.

Comparison of screening tools in patients undergoing haemodialysis

Background: Subjective Global Assessment (SGA) had been recommended by the Renal Association (Wright & Jones 2010) as an appropriate nutritional screening tool for the detection of malnutrition in haemodialysis (HD) patients. However, it has been criticised for being time consuming (Kondrup et al. 2003) and lacking sensitivity (Kalantar-Zadeh et al.1999). The Patient Generated Subjective Global Assessment (PG-SGA) requires the patient to complete part of the screening tool; thus reducing the amount of time the dietitian spends completing it. A recent pilot project showed that, compared to SGA, PG-SGA was able to distinguish significant differences between several independent measurements of nutritional status (demonstrating construct validity) (Hyam et al., 2010). In contrast the Malnutrition Universal Screening Tool (MUST) did not identify risk of malnutrition in HD patients. The aim of the current project was to assess a greater number and range of patients (with respect to nutritional status) using the three tools, in order to confirm whether PG-SGA was the most appropriate nutritional screening tool for use in HD patients. Methods: The nutritional status of 65 HD patients (n = 43 male; n = 22 female) attending two renal units; St Georges and Canterbury, was assessed by one investigator at each unit (KF and RP respectively). There was no exclusion criteria, however investigators aimed to assess a greater proportion of patients with suspected malnutrition (identified by SN and SR) as this group was possibly under-represented in the previous study. Data included SGA, MUST, PG-SGA, grip strength, anthropometric and biochemical parameters. Construct validity was examined using ANOVA to compare differences between the nutritional values of those patients classified by the nutritional screening tools as being at no risk, moderate risk or high risk of malnutrition. Criterion validity was assessed using the kappa statistic to measure the level of agreement between SGA (as the gold standard), PG-SGA, and MUST. Results: SGA classifications of nutritional status were able to distinguish significant differences in: Albumin (P = 0.03); CRP (P = 0.023), hand grip strength (P = 0.001), average daily energy intake (P = 0.005), protein intake (P = 0.01) and haemoglobin (P = 0.0001). PG-SGA only identified significant differences in hand grip strength (P = 0.008) and mid arm circumference (P = 0.024). MUST identified differences in current BMI (P = 0.04), mid arm circumference (P = 0.005) and CRP (P = 0.03). A moderate kappa statistic (0.51) was recorded when comparing the level of agreement between PGSGA and SGA classifications of patients. Virtually no agreement was found between SGA and MUST (( = 0.07). The sensitivity of PG-SGA compared to SGA was 89% and the specificity was 50%. When MUST was compared to SGA the sensitivity was 31% and the specificity was 95%. The majority (63%) of patients were unable to complete the PG-SGA; which were then completed with the assistance of the investigators. Discussion: MUST poorly identify malnourished HD patients (as found previously by Hyam et al., 2010). However in contrast to the pilot study, this current study which included a larger more nutritionally diverse group of patients, indicated that SGA was more sensitive to changes within independent nutritional parameters than PG-SGA. Over half the patients were not able to complete the PGSGA so, contrary to expectations, there were no time savings. Conclusion: SGA appears to be more sensitive to the nutritional status of HD patients than PG-SGA and additionally a large proportion of HD patients find PG-SGA too difficult to complete. MUST is not a sensitive method for detecting malnutrition in this group of patients.

Avaliação de métodos para identificar desnutrição energético-protéica de pacientes em hemodiálise

The method capable of best identifying protein-energy wasting (PEW) in hemodialysis (HD) patients is controversial. Thus, we assessed the nutritional status of HD patients by use of different methods and verified which one identified the highest number of patients with PEW. The study assessed the nutritional status of 15 HD patients (age: 52.7 ± 10.1 years; males: 33.3%) by use of anthropometric measurements, subjective global assessment (SGA), serum albumin, and dietary intake (24-hour food recall). Body fat was assessed by use of anthropometry. The International Society of Renal Nutrition and Metabolism (ISRNM) criteria were used to diagnose PEW. The body mass index (24.2 ± 4.4 kg/m²) and the percentage of standard value for mid-arm muscle circumference were within the normal limits (102.6 ± 13%). Nevertheless, the percentage of standard value for triceps skinfold was below the normal limits (females, 75.3 ± 40.4%; and males, 73.5 ± 20.6%), although a high body fat percentage was observed (females, 34.5 ± 7.3%; males, 23.6 ± 4.2%). When assessing the nutritional status by use of SGA, most patients (80%, n = 12) were malnourished, and SGA was the method that identified the highest number of patients with PEW. By using the ISRNM criteria, PEW was diagnosed in only two patients. All patients were diagnosed with PEW by use of one of the methods studied. The SGA was the method that, in isolation, could detect the greatest number of patients with PEW.

Acetate-free blood purification can impact improved nutritional status in hemodialysis patients

Effects of online hemodiafiltration (HDF) using acetate-free bicarbonate dialysis (AFD) fluid on microinflammation, resulting in improved nutritional status in hemodialysis patients, were examined and compared with conventional acetate-containing bicarbonate dialysis (ACD) fluid. A total of 24 hemodialysis patients were registered for a cross-over design study for a 6-month period. These patients were subjected to ACD for the first 3months followed by AFD fluid for the latter 3months. Blood variables of C-reactive protein (CRP), interleukin-6 (IL-6), leptin, neuropeptide Y (NPY), protein catabolic rate (PCR) and %creatinine (Cr) index were determined after the first and last 3-month period. The filters and the conditions of HDF and drug regimens including erythropoiesis-stimulating agents were unchanged throughout the cross-over study. Predialysis blood pH and bicarbonate were significantly higher in the AFD phase than in the ACD phase. Blood CRP and IL-6 levels were significantly decreased in the AFD group compared to the ACD group. Concerning nutritional evaluation, leptin and NPY were significantly lower and higher, respectively, in the AFD phase than in the ACD phase. PCR tended to be higher in the AFD phase than in the ACD phase. A significantly higher %Cr index level was observed in the AFD phase than in the ACD phase. These results suggest that online HDF using AFD fluid contributes to alleviating bioincompatible events associated with microinflammation, leading to improvement in the nutritional status in hemodialysis patients.

Three Months of Regular Gum Chewing Neither Alleviates Xerostomia nor Reduces Overhydration in Chronic Hemodialysis Patients

Gum chewing has been known to be a part of adjunctive medical therapy for cancer-related xerostomia. Nonadherence to fluid restriction in hemodialysis (HD) patients brought about by unrestricted thirst and xerostomia leads to excessive interdialytic weight gain (IWG). The effectiveness of gum chewing in reducing thirst in HD patients has till recently been evaluated by only a single study with short 2-week intervention period. The aim of the present study was to assess the effect of 3 months of regular use of sugar-free chewing gum on xerostomia, thirst, and hydration and nutritional status in HD patients. A prospective pre/post (3 + 1 month[s]) study including 38 chronic HD patients (14 women, 17 men; mean age, 59 ± 10 years; time on dialysis, 48 ± 45 months) with mean mid-week IWG of >1 kg, persistent xerostomia, and/or thirst was conducted. Seven patients did not complete the study including 3 because of suspected side effects of gum chewing (diarrhea or paradoxically increased thirst). After a 2-week run-in period, the subjects received a specified number of packs of low-tack, sugar-free chewing gum and specially designed diaries. Basic biochemistry and multifrequency electric bioimpedance were performed a total of 8 times, that is, at baseline and after each month of the intervention period, both before and after dialysis. Questionnaires related to xerostomia and thirst were filled in by the patients at baseline, at the end of the intervention period, and 1 month later. Body weight (for IWG assessment) and blood pressure were measured at the start of each dialysis for the whole duration of the study. The mean number of chewing gum pellets used during the first and the third month of the study was 137 ± 56 and 139 ± 59, respectively. The patients did not report experiencing any changes in the intensity of xerostomia and thirst during the study. Total body water content assessed with bioimpedance did not decrease (41.9 ± 8.9 kg at baseline vs. 42.7 ± 9.1 kg at the end of the intervention period). Moreover, no changes in extracellular mass (31.9 ± 6.4 kg vs. 32.6 ± 6.6 kg), extracellular water (18.0 ± 5.2 kg vs. 18.3 ± 5.0 kg), and phase angle (4.6 ± 0.8 vs. 4.6 ± 0.8) were observed. Mean IWG between 2 mid-weekly HD sessions also did not change (2.3 ± 0.8 kg at baseline vs. 2.3 ± 0.9 kg at the end of the intervention period). No significant changes in thirst and xerostomia were observed 4 weeks after the end of the intervention period; however, mean IWG between 2 mid-weekly HD sessions increased to 2.8 ± 1.0 kg (P < .001). Regular gum chewing is known to be well tolerated by most HD patients; however, it does not lead to the alleviation of xerostomia or excessive thirst and does not reduce IWG or improve hydration status.

Conventional, but not high-purity, dialysate-induced monocyte apoptosis is mediated by activation of PKC- and inflammatory factors release

Use of conventional dialysate (CD) (powdered sodium bicarbonate dissolved manually with reverse osmosis water before dialysis) is common in Chinese haemodialysis (HD) centres. However, this preparation carries the risk of degradation and contamination, potentially negatively impacting host defense. Commercially available high-purity dialysate (HPD) may decrease inflammation and improve nutritional status in HD patients. However, whether HPD affects immune cells is unclear. The purpose of this study was to investigate the in vitro effect of these dialysates on apoptosis in U937 monocytes and its possible mechanism. Following incubation with two different types of dialysate, U937 cell apoptosis was measured by flow cytometry. Cell morphological changes were observed by Hoechst 33258 fluorescence staining. The expression of protein kinase C-δ (PKC-δ) was assayed by RT-polymerase chain reaction and western blot. Cytokine levels in U937 cells after exposure to CD or HPD for an indicated time were assayed by commercial enzyme-linked immunosorbent assay. CD contained more bacteria (66 ± 6 CFU/mL) than HPD (7 ± 3 CFU/mL) while there was no difference in endotoxin levels. Compared with cells exposed to HPD and phosphate-buffered saline (PBS), U937 monocytes experienced more apoptosis when exposed to CD for 24 and 48 h, while there was no significant difference between HPD and PBS. Expressions of PKC-δ mRNA and protein in U937 cells were enhanced following exposure to CD for 24 and 48 h, with increased proteolytic cleavage of PKC-δ which could be inhibited by rottlerin, a specific inhibitor of PKC-δ. Moreover, the cultured supernatant in CD-exposed cells contained significantly higher levels of interleukin-6 (4.09 ± 0.36 vs 2.73 ± 0.38 pg/mL, P < 0.01, 24 h; 4.28 ± 0.32 vs 2.83 ± 0.32 pg/mL, P < 0.01, 48 h) and tumour necrosis factor α (3.45 ± 0.79 vs 2.44 ± 0.39 pg/mL, P < 0.05, 24 h; 4.60 ± 0.57 vs 2.50 ± 0.37 pg/mL, P < 0.01, 48 h) than those of HPD. CD, but not HPD, contained more bacterial contamination, increased monocyte apoptosis in a PKC-δ-dependent manner and induced more cell inflammation. These findings suggest that impurity of dialysis fluid may be an important determinant of the elevated inflammation seen in CD-treated patients.

Effects of Renal-specific Oral Supplementation in Malnourished Hemodialysis Patients

Protein-energy malnutrition is still a problem in patients with chronic renal failure, especially during replacement renal therapy. The chronic inflammatory status in these patients intensifies the malnutrition, as well as making treatment more complicated. The aim of the present study was to estimate the influence of oral supplementation on the nutritional status of malnourished hemodialysis (HD) patients depending on the existence of an inflammatory state. To study the influence of oral supplementation on nutrition status, 30 HD patients with protein-energy malnutrition characteristics and 25 well-nourished HD patients were enrolled in the study. Malnourished HD patients were prescribed Renilon 7.5 at an oral intake dose of 125 mL twice a day for 3 months. The nutritional status was characterized based on body mass index, Subjective Global Assessment score, serum albumin and prealbumin concentrations. The intensity of the inflammatory state was determined by C-reactive protein and interleukin-6. Serum concentrations of leptin and adiponectin were also measured. After 3 months of supplementation, malnourished patients had an increase in prealbumin, albumin, and leptin concentrations. No statistically significant differences were observed between patients lacking inflammation and those with inflammation. The results indicate an improvement in the nutritional status of HD patients who were prescribed an oral supplementation. Furthermore, patients with inflammatory state characteristics also benefited from Renilon 7.5 treatment.

Gender differences in the effect of fish oil on appetite, inflammation and nutritional status in haemodialysis patients

Haemodialysis patients show signs of chronic inflammation and reduced appetite, which is associated with a worse clinical status and an increased mortality risk. Fish oil has anti-inflammatory properties and may be useful as a therapeutic treatment. There is limited evidence to indicate the feasibility and efficacy of this intervention in dialysis patients. The present study aimed to compare the effect of 12 weeks of supplementation with fish oil on markers of appetite and inflammation in male and female haemodialysis patients. The study was conducted in 28 haemodialysis patients. All patients were prescribed 3 g of fish oil per day for 12 weeks. Changes in appetite, plasma fatty acid profiles and inflammatory markers were measured at baseline and at 12 weeks. The mean (SD) increase in percent plasma eicosapentaenoic acid was statistically significant [1.1 (0.8) to 4.1 (2.2), P < 0.001], which was a strong indicator of good adherence. There were trends towards reductions in peptide YY (-9%; P = 0.078) and an increase in subjective sensations of hunger (+12%; P = 0.406), which reflects an increase in motivation to eat. Males (n = 13) experienced a more marked increase in hunger compared to females (+23% versus -6%), which was associated with maintenance in C-reactive protein and interleukin-6, and a reduction in soluble intercellular adhesion molecule-1. The results obtained demonstrate meaningful trends towards improvements in subjective appetite and certain inflammatory markers (although no change in dietary intake) and this effect was more pronounced in males. However, the levels of some inflammatory markers increased in females and this requires further study. The high level of adherence achieved indicates that an intervention requiring patients to consume four fish oil capsules per day is achievable. This was a short-term study and the effects need to be confirmed in a randomised controlled trial.

Eating habits and nutritional status of hemodialysis patients

&lt;p&gt;Hemodialysis (HD) is a blood filtration process that removes excess of fluid and metabolites. The major determinants of morbidity and mortality in HD are the patients&amp;rsquo; nutritional status and dialysis adequacy. Probably there is a significant interrelationship between these two factors, as well as patients receiving adequate dialysis have a higher overall wellness and consequently better food intake. The aim of this study was to identify eating habits and nutritional status of patients registered in the hemodialysis program in the city of Foz do Igua&amp;ccedil;u-PR. Thirty-four patients were selected, 70.5% men and 29.5% women, in average 45 years old. To characterize the nutritional status were used Body Mass Index (BMI), total cholesterol, and Reduction Percentage Calculation of Urea (RPU). Dietary habits were investigated through a questionnaire on eating frequency. The results showed a predominance of normal individuals, according to BMI (47%), total cholesterol (60%) and RPU (80%) and the dietary habits showed that the results were not expected due to the socioeconomic level of patients. These results suggested that special attention must be given to maintaining the nutritional status of hemodialysis patients.&lt;/p&gt;&lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;DOI: http://dx.doi.org/10.14685/rebrapa.v1i2.24&lt;/p&gt;

Comparison of nutritional status in hemodialysis patients with and without failed renal allografts

The survival of patients returning to hemodialysis (HD) following kidney transplant failure is unfavorable. However, the factors responsible for this poor outcome are largely unknown; chronic inflammation due to failed allograft and malnutrition may contribute to morbidity and mortality. We aimed to compare the nutritional status and its relation with inflammation in patients on HD with and without previous kidney transplantation. Forty-three patients with failed renal allografts (27 males; mean age 36±9 yr) and 40 never transplanted HD patients (24 males; mean age 39±9 yr) were included in the study. Body weight, triceps (TSF), biceps (BSF), subscapular (SSSF), and suprailiac skinfold thicknesses (SISF); mid-arm, mid-arm muscle, hip and waist circumferences; as well as body mass indices (BMIs) were determined as anthropometric parameters. Moreover, biochemical markers of nutritional status, including serum cholesterol and albumin as well as high-sensitive C-reactive protein (hs-CRP), as a marker of inflammation, were measured. Associations among these variables were analyzed. There were no significant differences considering age, gender or duration of renal replacement therapy between the two groups. The TSF (p<0.0001), BSF (p=0.005), SSSF (p=0.001), SISF (p<0.0001) skinfold thicknesses; mid-arm (p=0.003) and mid-arm muscle circumferences (p=0.037) and BMIs (p=0.001) of the patients with failed renal allografts were significantly lower than those of the never transplanted HD patients. Waist circumference was significantly lower as well (p=0.028). Patients with failed transplants were characterized by lower serum albumin (p<0.0001) and higher hs-CRP levels (p=0.001) as compared with never transplanted HD patients. This study confirms the concept that retained failed allografts may induce chronic inflammation in chronic HD patients which may result in a worse nutritional status.

Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients

Malnutrition is a common complication in haemodialysis patients. Recently, the Geriatric Nutritional Risk Index (GNRI) has been reported as a simple and accurate tool to assess nutritional status of haemodialysis patients. Our objective was to examine the association between GNRI and mortality in chronic haemodialysis patients. We examined the GNRI of 490 maintenance haemodialysis patients (60 ± 12 years, 293 males and 197 females) and followed up these patients for 60 months. Predictors for all-cause death were examined using Kaplan-Meier analysis and Cox proportional analyses. The GNRI was 98.0 ± 6.0, and was significantly and negatively correlated with age and haemodialysis duration. During the 60-month follow-up period, 129 patients died. According to the highest positive likelihood and risk ratios, the cutoff value of GNRI for mortality was set at 90. Kaplan-Meier analysis revealed that patients with a GNRI <90 (n = 50) had a significantly lower survival rate, compared to those with GNRI ≥90 (n = 440) (log-rank test, P < 0.0001). Multivariate Cox proportional hazards analyses demonstrated that GNRI was a significant predictor for mortality [hazard ratio (HR) 0.962, 95% confidence interval (CI) 0.931-0.995, P < 0.05], after adjustment for age, gender, C-reactive protein, presence of diabetes and haemodialysis duration. These results demonstrated that GNRI is a significant predictor for mortality in haemodialysis patients. The simple method of GNRI is considered to be a clinically useful marker for the assessment of nutritional status in haemodialysis patients.

Association of nutritional status and diet quality in hemodialysis patients

Variety and adequacy of food intake as well as dietary pattern affect nutritional status of hemodialysis (HD) patient's. The aim of this study was to investigate the quality of diet and nutritional status in HD patients and to find out the relationships among the variables. We assessed nutritional status and diet quality of 63 HD patients (age: 55.3 ± 11.9 yrs; men/women ratio: 49.2%/50.8%) using Subjective Global Assessment (SGA) and 3‐day diet recall methods, respectively. Patient's daily energy intake (DEI) and protein intake (DPI) were 21.9 ± 6.7 kcal/BW/day and 0.9 ± 0.3 g/BW/day, respectively. About 70% of HD patients appeared to have lower daily energy and protein intake compared to recommended amount. More than 50% of HD patients had lower intake of vitamin C, B1, B2, niacin, folate, calcium, and zinc below75% of Dietary recommended intakes. Nutrient intakes per 1,000kcal indicated that HD patients had diets that were lower in nutrient density for Vitamin C, B1, B2, folate, and calcium. There was significant positive correlation between DEI and SGA scores (r=0.3, p&lt;0.05). DQI‐I was significantly correlated with DEI, DPI and lean body mass (kg) (r=0.5, p&lt;0.01; r=0.4, p&lt;0.01; r=0.3, p&lt;0.05, respectively). As increased in disease severity measured by End‐Stage Renal Disease Severity Index (ESRD‐SI), FVS score decreased (r=−0.3, p&lt;0.05). The results of this study indicate that HD patients in Korea consumed less calories, protein, vitamin C, B1, B2, folate, and calcium than recommended amount for each nutrient for HD patients. This study also confirmed that nutritional status and disease severity were significantly correlated with dietary quality.Grant Funding Source: ASN

The Phase Angle and Mass Body Cell as Markers of Nutritional Status in Hemodialysis Patients

Bioelectrical impedance analysis (BIA) is a fast, noninvasive method for assessing body composition, and its role in the evaluation of nutritional status in haemodialysis (HD) has been studied. This study aimed to compare BIA parameters to clinical, biochemical, and anthropometric markers of nutrition in HD patients, such as subjective global assessment modified for renal disease (SGA-1), serum albumin, body mass index (BMI), percent of standard body weight (%SBW), deviation of triceps skinfold thickness (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC) from the standard value (50th percentile), anthropometry-derived fat (FM-A), and fat-free mass (FFM-A). BIA was performed 30 minutes after a HD session and the reactance (Xc), resistance (R), phase angle (PA), body cell mass (BCM), fat mass (FM-BIA), and fat-free mass (FFM-BIA) values were recorded. The prevalence of malnutrition was estimated according to PA and percent of BCM. The correlation between methods was assessed through Pearson's correlation coefficient and Bland and Altman analysis. A total of 58 patients were studied (30 women and 28 men; mean age of 49.2 +/- 14.8 years). The mean PA was 6.19 +/- 1.33 degrees and the mean percent of BCM was 33.75 +/- 5.91%. The prevalence of malnutrition was 17.5% and 43.9% according to the PA and percent of BCM, respectively. PA had a negative correlation with age and SGA-1 score and a positive correlation with percent SBW, MAC, MAMC, FFM-A, and albumin. Percent of BCM had a negative correlation with age, MAC, MAMC and FM-A and a positive correlation with FFM-A and albumin. A significant correlation between FFM-A and FFM-BIA was observed, as well as between FM-A and FM-BIA. BIA indexes reflected nutritional state. PA and BCM seem to be less influenced by changes in volume and can be used for nutritional assessments of dialysis patients.

Independent and Joint Associations of Nutritional Status Indicators With Mortality Risk Among Chronic Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

To consider the Kidney Disease Outcomes Quality Initiative recommendation of using multiple nutritional measurements for patients on maintenance dialysis, we explored data for independent and joint associations of nutritional indicators with mortality risk among maintenance hemodialysis patients treated in 12 countries. Dialysis units in seven European countries, the United States, Canada, Australia, New Zealand, and Japan. Mortality risk. We conducted a prospective cohort study of 40,950 patients from phases I to III of the Dialysis Outcomes and Practice Patterns Study (1996-2008). Independent and joint effects (interactions) of nutritional indicators (serum creatinine, serum albumin, normalized protein catabolic rate, body mass index [BMI]) on mortality risk were assessed by Cox regression with adjustments for demographics, years on dialysis, and comorbidities. Important variations in nutritional indicators were seen by country and patient characteristics. Poorer nutritional status assessed by each indicator was independently associated with higher mortality risk across regions. Significant multiplicative interactions (each p < or = 0.01) between indicators were also observed. For example, by using patients with serum creatinine 7.5-10.5 mg/dL and BMI 21-25 kg/m(2) as referent, BMI <21 kg/m(2) was associated with lower mortality risk among patients with creatinine >10.5 mg/dL (relative risk = 0.68) but with higher mortality risk among those with creatinine <7.5 mg/dL (relative risk = 1.38). The association of lower albumin concentration with higher mortality risk was stronger for patients with lower BMI or lower creatinine. The joint effects of nutritional indicators on mortality indicate the need to use multiple measurements when assessing the nutritional status of hemodialysis patients.

Determinants of Resting Energy Expenditure in Hemodialysis Patients, and Comparison With Healthy Subjects

This study evaluated the factors that affect the resting energy expenditure (REE) and nutritional status of hemodialysis patients, and to assess any differences with healthy subjects. This was an observational case-control study. This study took place at the Hemodialysis Units of the Laikon General Hospital and 401 General Military Hospital (Athens, Greece). Twenty-five patients undergoing hemodialysis and 23 controls were recruited. Controls were healthy volunteers with no history of diseases or medication use. Patients with active infectious or inflammatory disease were excluded. We measured REE using indirect calorimetry. Body composition as measured by Bioelectrical Impedance Analysis (BIA), anthropometry, and biochemical parameters were assessed in both groups. Adjusted or unadjusted for muscle mass, REE was compared between the two groups. Multiple linear regression analysis was used to study independent determinants of REE. Patients had no clinical signs of malnutrition. Resting energy expenditure was not different between the two groups, but REE adjusted for muscle mass was significanlty higher in hemodialysis patients. There were no differences in body composition, with the exception of muscle mass. Patients had lower muscle mass than controls, as determined by duration of disease. The only significant determinant of REE was muscle mass. Patients had a higher REE adjusted for muscle mass than did controls, implying that they might be at a catabolic stage, and at risk of malnutrition. These findings indicate the need for determining body composition and for nutritional assessment and support in hemodialysis patients, even without indications of malnutrition.

Modified Mininutritional Assessment Can Effectively Assess the Nutritional Status of Patients on Hemodialysis

We sought to determine whether the MNA (Mininutritional Assessment) would be an effective tool for assessing the nutritional status of patients undergoing hemodialysis. Purposive sampling. Two hospital-managed hemodialysis centers in central Taiwan. Subjects were 95 ambulatory patients older than 40 years without acute diseases or infections who had received hemodialysis treatment at the center for longer than 30 days. Each subject was interviewed with a structured questionnaire to elicit basic personal data and health- and lifestyle-related information and answered questions on the Council on Nutrition Appetite Questionnaire and MNA. Serum biochemical data were obtained from their routine measurement. The nutritional status of each subject was graded with two modified MNA versions. MNA-TI adopted population-specific anthropometric cut-points, and MNA-TII further had the body mass index question deleted from the scale and question scores adjusted but maintained the same 30 total points. Based on the strength of correlation with the key nutrition-related parameters including appetite status, serum creatinine, percent weight loss, hospital length of stay, number of prescribed drugs, and hemodialysis time, both modified MNA versions reflected the nutritional status of Taiwanese hemodialysis patients better than the Council on Nutrition Appetite Questionnaire. Serum albumin did not reflect nutritional status well in these hemodialysis patients. MNA-TI predicted 26.4% and MNA-TII predicted 29.5% of hemodialysis patients were either malnourished or at risk of malnutrition. Both versions of the modified MNA are effective in assessing the nutritional status of hemodialysis patients. MNA-TII without body mass index is a significant improvement for hemodialysis patients because body weights fluctuate significantly between dialysis sessions.

Comparision of nutritional status of hemodialysis patients with different ages and its nursing strategy

Objective To explore the nutritional status of hemodialysis patients with different ages, and analyze the reasons of differences of nutritional status. Methods 109 hemodialysis patients were divided into the young-age group (n=26), the middle-age group (n=49) and the old-age group (n=34). The body indices, blood biochemical parameters, dietary assessment, handgrip strength and subjective global assessment were measured. The nutritional indices and relationship were compared among patients in the three groups. Results Leg circumstance, prealbumin, creatinine, handgrip strength and SGA scores were different among the three groups (P<0.05 or P<0.01). And those five factors were all statistically associated with age (P<0.05). Conclusions With the increase of age, the hemodialysis patients' nutritional status has a descending trend. It's necessary for nursing staff to timely monitor and intervene the nutrition of elderly patients so as to prevent the incidence of malnutrition. Key words: Renal dialysis; Nutritional status; Nutrition assessment; Age factors; Nursing care