Re. Effectiveness of protein-caloric supplementation in hemodialysis patients to improve the amino acid balance and avoid protein energy wasting: Author's response

Nutrition ◽  
2019 ◽  
Vol 62 ◽  
pp. 211
Author(s):  
Sylwia Małgorzewicz
Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1773 ◽  
Author(s):  
Piergiorgio Bolasco

This review aims to highlight the strengths and weaknesses emerging from diagnostic evaluations and prescriptions in an intent to prevent progression over time of malnutrition and/or protein-energy wasting (PEW) in hemodialysis (HD) patients. In particular, indications of the most effective pathway to follow in diagnosing a state of malnutrition are provided based on a range of appropriate chemical-clinical, anthropometric and instrumental analyses and monitoring of the nutritional status of HD patients. Finally, based on the findings of recent studies, therapeutic options to be adopted for the purpose of preventing or slowing down malnutrition have been reviewed, with particular focus on protein-calorie intake, the role of oral and/or intravenous supplements and efficacy of some classes of amino acids. A new determining factor that may lead inexorably to PEW in hemodialysis patients is represented by severe amino acid loss during hemodialysis sessions, for which mandatory compensation should be introduced.


Nutrition ◽  
2019 ◽  
Vol 57 ◽  
pp. 231-236 ◽  
Author(s):  
Sylwia Małgorzewicz ◽  
Grażyna Gałęzowska ◽  
Monika Cieszyńska-Semenowicz ◽  
Joanna Ratajczyk ◽  
Lidia Wolska ◽  
...  

Author(s):  
Ting-Yun Lin ◽  
Szu-Chun Hung

Abstract Background Protein-energy wasting (PEW) is prevalent and associated with adverse outcomes in patients with chronic kidney disease (CKD). However, the pathogenesis of PEW in CKD patients has not been fully identified. The gut microbiota has been implicated in the regulation of host metabolism and energy balance. Therefore, we aimed to explore the association between nutritional status and the composition of the gut microbiota in hemodialysis patients. Methods Gut microbial diversity and taxonomy were examined in 88 hemodialysis patients with PEW (n = 22) and normal nutritional status (n = 66) who were matched 1:3 for age and sex. Nutritional status was assessed by using the 7-point subjective global assessment (SGA) score (1–3 = severe PEW; 4–5 = moderate PEW and 6–7 = normal nutrition). The gut microbiota was assessed by 16S ribosomal RNA gene sequencing. Results Patients with normal nutritional status had a significantly higher body mass index and physical activity and serum albumin levels, but significantly lower levels of inflammatory cytokines than patients with PEW. The most striking finding was that the α-diversity of the gut microbiota was significantly lower in patients with PEW. In a multivariate analysis, the SGA score was independently and positively associated with α-diversity (P = 0.049). Patients with or without PEW were different with respect to the principal coordinate analysis of β-diversity. Notably, the relative abundance of Faecalibacterium prausnitzii, a butyrate-producing bacteria, was markedly reduced in patients with PEW. Conclusion In hemodialysis patients, PEW assessed with the SGA was associated with gut dysbiosis.


PLoS ONE ◽  
2020 ◽  
Vol 15 (7) ◽  
pp. e0236948
Author(s):  
Julien Aniort ◽  
Marine Freist ◽  
Aurélien Piraud ◽  
Carole Philipponnet ◽  
Mohamed Hadj Abdelkader ◽  
...  

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