scholarly journals N-terminal Pro-B-Type Natriuretic Peptide and Malnutrition in Patients on Hemodialysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jacques Ducros ◽  
Laurent Larifla ◽  
Henri Merault ◽  
Valérie Galantine ◽  
Valérie Bassien-Capsa ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Natriuretic Peptide ◽  
Prognostic Value ◽  
Weight Status ◽  
Fluid Overload ◽  
Dietary Intakes ◽  
Protein Energy Wasting ◽  
Current Review ◽  
Protein Energy

Natriuretic peptides, brain natriuretic peptide (BNP), and N-terminal probrain natriuretic peptide (NT-proBNP) are mainly known as diagnostic markers for heart failure with high diagnostic and prognostic values in the general population. In patients who are undergoing hemodialysis (HD), changes in NT-proBNP can be related to noncardiac problems such as fluid overload, inflammation, or malnutrition and can also be influenced by the dialysis characteristics. The current review aimed to summarize findings from studies on the association between NT-proBNP and malnutrition in HD patients. Articles published after 2009 and over a ten-year period were considered for inclusion. We first briefly discuss the traditional functions of NT-proBNP, and after, we describe the functions of this prohormone by focusing on its relation with protein energy wasting (PEW) in HD patients. Mechanisms that could explain these relationships were also discussed. Overall, 7 studies in which the investigation of the relations between NT-proBNP and nutritional status in HD patients were among the main objects were taken into account. NT-proBNP levels correlated with several factors described in the 4 categories of markers indicative of PEW (body mass and composition, muscle mass, biochemical criteria, and dietary intakes) and/or were associated with PEW. Interactions between several parameters could be involved in the association between NT-proBNP and malnutrition with a strong role of weight status. NT-proBNP is elevated in HD patients and is associated with malnutrition. Nevertheless, the prognostic value of NT-proBNP on nutritional status should be evaluated.

Association of subjective global assessment of nutritional status with gut microbiota in hemodialysis patients: a case–control study

2020 ◽  
Author(s):  
Ting-Yun Lin ◽  
Szu-Chun Hung
Keyword(s):  
Nutritional Status ◽  
Gut Microbiota ◽  
Global Assessment ◽  
Hemodialysis Patients ◽  
Adverse Outcomes ◽  
Subjective Global Assessment ◽  
Protein Energy Wasting ◽  
Β Diversity ◽  
Protein Energy ◽  
Α Diversity

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.

scholarly journals Exploring Metabolic Signature of Protein Energy Wasting in Hemodialysis Patients

Metabolites ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 291 ◽  
Author(s):  
Fatin Athirah Pauzi ◽  
Sharmela Sahathevan ◽  
Ban-Hock Khor ◽  
Sreelakshmi Sankara Narayanan ◽  
Nor Fadhlina Zakaria ◽  
...  
Keyword(s):  
Weight Status ◽  
Partial Least Square ◽  
Least Square ◽  
Controlled Study ◽  
Plasma Metabolites ◽  
Maintenance Hemodialysis ◽  
Protein Energy Wasting ◽  
Metabolic Pattern ◽  
Metabolic Alteration ◽  
Protein Energy

End-stage renal disease patients undergoing maintenance hemodialysis (HD) are vulnerable to the protein energy wasting (PEW) syndrome. Identification and diagnosis of PEW relies on clinical processes of judgment dependent on fulfilling multiple criteria drawn from serum biochemistry, weight status, predictive muscle mass, dietary energy and protein intakes. Therefore, we sought to explore the biomarkers’ signature with plasma metabolites of PEW by using 1H-nuclear magnetic resonance for an untargeted metabolomics approach in the HD population, to understand metabolic alteration of PEW. In this case-controlled study, a total of 53 patients undergoing chronic HD were identified having PEW based on established diagnostic criteria and were age- and sex-matched with non-PEW (n = 53) HD patients. Fasting predialysis plasma samples were analyzed. Partial least square discriminant analysis demonstrated a significant separation between groups for specific metabolic pattern alterations. Further quantitative analysis showed that the level of 3-hydroxybutyrate, acetate, arabinose, maltose, ribose, sucrose and tartrate were significantly increased whilst creatinine was significantly decreased (all p < 0.05) in PEW subjects. Pathway analysis indicated that PEW-related metabolites reflected perturbations in fatty acid mechanism and induction of glyoxylate and dicarboxylate pathway attributed to gluconeogenesis. These results provide preliminary data in understanding metabolic alteration of PEW and corresponding abnormal metabolites that could potentially serve as biomarkers of PEW.

scholarly journals Nutritional Status in Peritoneal Dialysis: Nutritional Guidelines, Adequacy and the Management of Malnutrition

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1715 ◽  
Author(s):  
Thomas Kiebalo ◽  
Jacqueline Holotka ◽  
Ireneusz Habura ◽  
Krzysztof Pawlaczyk
Keyword(s):  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Positive Impact ◽  
Protein Energy Wasting ◽  
Innovative Strategies ◽  
Nutritional Recommendations ◽  
Protein Energy ◽  
Accessible Information ◽  
Concise Information ◽  
Treatment Adequacy

The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialyzed patients has been well established. Protein intake is an important factor used to stratify malnutrition, with inadequate intake leading to protein-energy wasting during the course of therapy. In this review, we discuss the recommendations made by nephrological societies regarding nutrition in this population of dialysis patients. Special attention is given to the intake of protein, and recommendations on the intake of micronutrients are also discussed. Furthermore, factors that may impair nutritional intake and balance are discussed, with mention of the innovative strategies utilized to combat them. In light of inconsistent recommendations that vary between each respective society, as well as a general lack of concise information, it is our intention to call for further research regarding nutritional recommendations in peritoneal dialysis (PD), as well as to advocate for clear and accessible information for patients.

Nutrition in Children with Kidney Disease: Pitfalls of Popular Assessment Methods

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 143-146 ◽  
Author(s):  
Bethany J. Foster ◽  
Mary B. Leonard
Keyword(s):  
Body Composition ◽  
High Risk ◽  
Kidney Disease ◽  
Nutritional Status ◽  
Nutritional Assessment ◽  
Fluid Overload ◽  
Protein Energy Malnutrition ◽  
Protein Energy ◽  
Accurate Picture ◽  
Pubertal Delay

Children with chronic kidney disease (CKD) are considered at high risk for protein-energy malnutrition. Clinical practice guidelines generally recommend an evaluation of numerous nutritional parameters to give a complete and accurate picture of nutritional status. This review summarizes the potential limitations of commonly used methods of nutritional assessment in the setting of CKD. Unrecognized fluid overload and inappropriate normalization of body composition measures are the most important factors leading to misinterpretation of the nutritional assessment in CKD. The importance of expressing body composition measures relative to height or height-age in a population in whom short stature and pubertal delay are highly prevalent is emphasized. The limitations of growth as a marker for nutritional status are also addressed. In addition, the prevailing belief that children with CKD are at high risk for malnutrition is challenged.

scholarly journals Intradialytic nutrition and quality of life in Chilean older patients in hemodialysis with protein-energy wasting

2021 ◽  
Author(s):  
Mariana Ayala ◽  
Margarita Marchant ◽  
Cristina Hertz ◽  
Gloria Castillo
Keyword(s):  
Quality Of Life ◽  
Body Composition ◽  
Nutritional Status ◽  
Older Patients ◽  
Nutritional Supplementation ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Before And After ◽  
The Impact

Abstract Purpose The study assessed the impact of intradialytic oral nutritional supplementation on the quality of life in patients receiving hemodialysis and diagnosed with protein energy wasting. Methods A pre-test post-test quasi-experimental study was conducted before and after 3 months of intradialytic oral nutritional supplementation on 109 older hemodialysis patients. We measured before and after 3 months of intradialytic oral nutritional supplementation, the quality of life score, the burden of kidney disease, three quality of life scales and the mental and physical health status using KDQoL-SF™ 1.3, body composition and biochemical parameters of nutritional condition. Results The mean age of the patients was 69.4 ± 3.4 years, 59% were male, and the time on dialysis was 63.5 ± 52.6 months. Comparing the baseline with month 3 of intradialytic oral nutritional supplementation, we observed to better quality of life. In contrast to malnutrition, score, specifically increased significantly score of symptoms/problems list related to hemodialysis, sexual function, social and cognitive function, sleep, pain, energy/fatigue and general state of health. Significant changes were also found in nutritional status, energy intake and body composition indicators. After 3 months of intradialytic oral nutritional supplementation, we observed a nutritional status recovery in one or more indicators in 92% of the patients. Conclusion Our findings indicate that 3 months of intradialysis oral nutritional supplementation improves the components of physical and mental quality of life and nutritional status in older patients receiving hemodialysis diagnosed with loss of protein energy. These results are relevant to improve the experience of patients with protein energy loss receiving hemodialysis.

scholarly journals Eating during the Hemodialysis Session: A Practice Improving Nutritional Status or a Risk Factor for Intradialytic Hypotension and Reduced Dialysis Adequacy?

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1703 ◽  
Author(s):  
Eleni Fotiadou ◽  
Panagiotis I. Georgianos ◽  
Michail Chourdakis ◽  
Pantelis E. Zebekakis ◽  
Vassilios Liakopoulos
Keyword(s):  
Nutritional Status ◽  
Caloric Intake ◽  
Intradialytic Hypotension ◽  
Protein Energy Wasting ◽  
Dialysis Adequacy ◽  
Hemodialysis Treatment ◽  
Protein Energy ◽  
Increased Risk ◽  
Related Quality ◽  
Inflammatory State

Historically, eating during the hemodialysis treatment has been associated with increased risk for adverse intradialytic symptoms and events, risks that have resulted in the implementation of restrictive in-center nutrition policies. Recent studies, however, have recorded a shift in clinical practice with a higher proportion of physicians following the view that administration of intradialytic meals and supplements represents a simple and effective approach to enhance caloric intake and improve nutritional status among patients on hemodialysis. This shift towards less restrictive in-center nutrition practices is mainly supported by evidence from observational studies associating intradialytic nutritional supplementation with improvements in protein-energy wasting, inflammatory state, and health-related quality of life. In sharp contrast, earlier and recent interventional studies have documented that feeding during the hemodialysis treatment provokes a rapid postprandial decline in blood pressure and raises the incidence of symptomatic intradialytic hypotension. Furthermore, other studies have shown that postprandial redistribution in intravascular volume and enhanced blood supply to the gastrointestinal circulation may interfere with the adequacy of the delivered hemodialysis. Those who defend the position that intradialytic nutritional support is beneficial do not dispute the physiology of postprandial hemodynamic response, but they argue against its clinical significance. In this article, we provide an overview of studies that explored the effect of eating during the hemodialysis treatment on intradialytic hemodynamic stability and adequacy of the delivered hemodialysis. We reason that these risks have important clinical implications that are not counteracted by anticipated benefits of this strategy on caloric intake and nutritional status.

The role of oxidative stress in the development of protein-energy wasting and sarcopenia in patients with stage 5D chronic kidney disease

Nephrology ◽  
2021 ◽  
Vol 2_2021 ◽  
pp. 41-46
Author(s):  
M.Z. Gasanov Gasanov ◽  
V.M. Negoda Negoda ◽  
M.M. Batyushin Batyushin ◽  
◽  
◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Protein Energy Wasting ◽  
Protein Energy

scholarly journals FP774EVALUATION OF NUTRITIONAL STATUS IN HEMODIALYSIS ADD SERUM PREALBUMIN TO THE PROTEIN ENERGY WASTING SCORE IS IT BENEFICIAL ?

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii336-iii336
Author(s):  
Fourtage Marion ◽  
Bazin Kara Dorothee ◽  
Krummel Thierry ◽  
Hannedouche Thierry
Keyword(s):  
Nutritional Status ◽  
Protein Energy Wasting ◽  
Protein Energy

scholarly journals Hemodialysis—Nutritional Flaws in Diagnosis and Prescriptions. Could Amino Acid Losses Be the Sharpest “Sword of Damocles”?

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1773 ◽  
Author(s):  
Piergiorgio Bolasco
Keyword(s):  
Amino Acids ◽  
Amino Acid ◽  
Hemodialysis Patients ◽  
Calorie Intake ◽  
Protein Energy Wasting ◽  
Slowing Down ◽  
Protein Energy ◽  
Determining Factor ◽  
Over Time

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.

scholarly journals NT-proBNP, Cardiometabolic Risk Factors, and Nutritional Status in Hemodialysis Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Jacques Ducros ◽  
Laurent Larifla ◽  
Henri Merault ◽  
Lydia Foucan
Keyword(s):  
Nutritional Status ◽  
Cross Sectional Study ◽  
Dialysis Patients ◽  
Protein Energy Wasting ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Wasting Syndrome ◽  
Protein Energy ◽  
Catabolic Rate ◽  
Dialysis Vintage

Background.We aimed to evaluate the association between NT-proBNP and malnutrition in HD patients while taking into account the four established categories of parameters for diagnosis of protein energy wasting (PEW).Methods. A cross-sectional study was performed in Afro-Caribbean dialysis patients. One component in each of the 4 categories for the wasting syndrome was retained: serum albumin ≤ 38 g/L, BMI ≤ 23 Kg/m2, serum creatinine ≤ 818 µmol/L, and normalized protein catabolic rate (nPCR) ≤ 0.8 g/kg/day. NT-proBNP was assessed using a chemiluminescence immunoassay. Two multivariate logistic regression models were performed to determine the parameters associated with high NT-proBNP concentrations.Results.In 207 HD patients, 16.9% had PEW (at least three components). LVEF lower than 60% was found in 13.8% of patients. NT-proBNP levels ranged from 125 to 33144 pg/mL. In model 1, high levels of NT-proBNP (≥6243 pg/mL) were independently associated with PEW OR 14.2 (3.25–62.4), male gender 2.80 (1.22–6.57), hsCRP > 5 mg/L 3.90 (1.77–8.57), and dialysis vintage > 3 years 3.84 (1.35–10.8). In model 2, LVEF OR was 0.93 (0.88–0.98). NT-proBNP concentrations were significantly higher when the PEW component number was higher.Conclusion.In dialysis patients, high NT-proBNP levels must draw attention to cardiac function but also to nutritional status.

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