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.

PP130 Oral Supplements For Protein-Energy Wasting In Chronic Kidney Disease

2019 ◽  
Vol 35 (S1) ◽  
pp. 61-62
Author(s):  
Noe Brito-Garcia ◽  
Ana Toledo-Chávarri ◽  
Maria Trujillo-Martin ◽  
Beatriz Leon-Salas ◽  
Pedro Serrano ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Status ◽  
Comparative Studies ◽  
Nutritional Therapy ◽  
Serum Markers ◽  
Dietary Recommendations ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Related Quality

IntroductionMalnutrition, specifically protein-energy wasting (PEW), is common in patients with chronic kidney disease (CKD), and its prevalence increases as CKD progresses. Oral nutritional supplementation (ONS) with complete formulas specific to this pathology, is a strategy aimed at meeting energy and protein requirements that are not possible with dietary recommendations and advice alone. This study systematically reviewed the available scientific literature on the safety and effectiveness of nutritional therapy with complete formulas specially designed for adults with CKD who have PEW that is not reversible through ordinary food consumption.MethodsWe systematically searched for articles published up to May 2018 in several electronic databases. We included comparative studies that evaluated the safety and effectiveness of complete nutritional formulas for malnourished adults with CKD. Relevant outcomes included rates of death, hospitalization, and adverse effects, and changes in nutritional status, anthropometrics, and health-related quality of life (HRQoL).ResultsThree systematic reviews and 22 primary studies were identified. The primary studies comprised nine randomized controlled trials, nine non-randomized comparative studies, and four before-after studies (the latter were only included in the safety review). The majority of studies were conducted in patients on hemodialysis. The studies exhibited methodological heterogeneity in terms of the methods used to measure nutritional status and the interventions and comparators evaluated. There was also inconsistency among the results. Adherence to ONS, especially in the long term, can be affected by taste fatigue produced by repeatedly taking the same formula. Some studies recommend supplementation during hemodialysis sessions.ConclusionsThe studies with less risk of bias indicated a trend toward improvements in rates of death and hospitalization, HRQoL and, to a lesser extent, some anthropometric variables and serum markers, such as albumin, when ONS was given to patients with CKD. High quality comparative studies are needed to make conclusive statements about the effectiveness of this intervention.

Nutritional Support in Acute Kidney Injury

2018 ◽  
Author(s):  
Alice Sabatino ◽  
Giuseppe Regolisti ◽  
Filippo Fani ◽  
Enrico Fiaccadori
Keyword(s):  
Acute Kidney Injury ◽  
Oxidation Rate ◽  
Nutritional Support ◽  
Rapid Change ◽  
Kidney Injury ◽  
Resting Energy Expenditure ◽  
Protein Energy Wasting ◽  
Mortality And Morbidity ◽  
Protein Energy ◽  
Increased Risk

Protein-energy wasting (PEW) is particularly common in patients with acute kidney injury (AKI). It is correlated, at least in part, with specific factors of the reduction of renal function and is associated with significant increase in mortality and morbidity. In this clinical condition, the optimal nutritional support remains an open question due to its qualitative composition in terms of macro- and micronutrients. In fact, data on critically ill patients have confirmed that nutritional support targeting the real protein and energy needs is associated with improvement of clinical outcome. However, data available in AKI patients are still scarce. AKI is characterized by increased risk of both under- and overfeeding because of the coexistence of many factors that can influence the evaluation of nutrient needs, such as a rapid change in body weight due to alterations in fluid balance, loss of nutrients during renal replacement therapy (RRT), and the presence of hidden calories in the RRT (ie, calories derived from anticoagulants and/or from solutions used in the different dialysis methods). As AKI comprises a highly heterogeneous group of patients, with oscillatory nutrient needs during patients’ clinical course, nutritional requirements should be frequently reassessed, individualized, and carefully integrated with RRT. Nutrient needs in patients with AKI can be difficult to estimate and should be directly measured, especially in the intensive care unit setting. This review contains 4 figures, 3 tables and 104 references Keywords: Malnutrition In ICU Patients,  Acute Kidney Injury, Nutritional Support, Indirect Calorimetry, Resting Energy Expenditure, Lipid Oxidation Rate, Glucose Oxidation Rate, Micronutrients

scholarly journals Qualidade da dieta, risco cardiovascular e estado nutricional de trabalhadores assistidos pelo Programa de Alimentação do Trabalhador

2020 ◽  
Vol 35 (1) ◽  
pp. 56-61
Author(s):  
Elisangela de Meira ◽  
Fernanda Rebequi ◽  
Diana Souza Santos Vaz ◽  
Caryna Eurich Mazur
Keyword(s):  
At Risk ◽  
Nutritional Status ◽  
Caloric Intake ◽  
Meat Industry ◽  
Food Groups ◽  
Eating Pattern ◽  
Food Pyramid ◽  
Increased Risk ◽  
Nutritional Monitoring

Introduction: Due to the various changes that have occurred in people’s diet and lifestyle, there is an increase in the prevalence of overweight, as well as an increased risk and development of cardiovascular disease (CVD). It is important to assess the quality of food, to know it and to develop appropriate interventions, especially for workers, since they eat most of their meals away from home and are at risk for CVD. The objective of this study was to evaluate the nutritional status, the quality of the diet and its relationship with CVD in meat industry workers. Methods: Crosssectional study conducted from October to December 2017. Forms were used, anthropometric and dietary evaluation of workers of a meat industry in the municipality of Pitanga, Paraná, Brazil. Nutrabem® software was used to calculate and evaluate food consumption, which determined the descriptive values of the diet quality index (IQD), based on the food groups according to the food pyramid. The IQD was divided into three categories: 80 to 100 points - healthy diet, 50 to 79 points - needs adjustments in the eating pattern, less than 49 points inadequate diet. Results: 55 employees were included with a mean age of 32.2 ± 9.92 years, predominantly male (67.3%), average body mass index of 27.05 ± 4.90 kg/m², with values in the group at risk of CVD according to waist-to-height ratio. The average IQD was 52.0 ± 10.9 points, with 40% (n = 22) of employees classified with inadequate diet and 60% (n = 33) needing adjustment in diet, women showed a tendency to diet. inadequate compared to men (p <0.05). Conclusion: Nutritional status, age and caloric intake was related to the quality of the diet and the risk for CVD. It is important the nutritional monitoring and intervention actions with the working class.

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 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.

scholarly journals A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients with Chronic Kidney Disease

2019 ◽  
Vol 49 (1-2) ◽  
pp. 202-211 ◽  
Author(s):  
Ramy M. Hanna ◽  
Lena Ghobry ◽  
Olivia Wassef ◽  
Connie M. Rhee ◽  
Kamyar Kalantar-Zadeh
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Caloric Intake ◽  
Nutritional Risk ◽  
Protein Energy Wasting ◽  
Dietary Counseling ◽  
Holistic View ◽  
Reverse Epidemiology ◽  
Protein Energy

Objectives of Review: Protein-energy wasting (PEW) is a state of disordered catabolism resulting from metabolic and nutritional derangements in chronic disease states. Patients with chronic kidney disease (CKD), and end-stage renal disease (ESRD) in particular, have muscle wasting, sarcopenia, and cachexia that contribute to frailty and morbidity. Moreover, reverse epidemiology findings have strongly linked PEW with mortality in CKD and ESRD. Updated Findings: The malnutrition-inflammation score (KALANTAR Score) provides a useful tool to predict nutritional risk. A stronger focus on renal nutrition in renal patients is needed to attenuate cachexia and muscle loss. Malnutrition is a far greater threat in patients with renal disease than obesity, which means dietary counseling needs to be tailored to reflect this observation. The need to achieve optimal caloric intake is compounded by the need to limit excess protein intake in CKD, resulting in the need for energy supplementation to avoid PEW. Preventing PEW is the most pressing clinical concern in CKD/ESRD. Other nutritional issues to reckon in renal disease include the need to normalize serum bicarbonate to manage acidosis, uric acid control, and phosphorous control in CKD and ESRD. Exercise maybe beneficial, but further work is needed to prove a conclusive benefit via a randomized trial. Summary: PEW prevention is an integral part of renal nutrition and is of paramount importance given the obesity paradox. Integrative approaches by physicians and dieticians are needed to take a holistic view of a patient’s diet beyond just control of particular laboratory parameters.

scholarly journals Evaluation of dysphagia risk, nutritional status and caloric intake in elderly patients with Alzheimer's

2014 ◽  
Vol 22 (2) ◽  
pp. 317-324 ◽  
Author(s):  
Vanessa Fernanda Goes ◽  
Pâmela Billig Mello-Carpes ◽  
Lilian Oliveira de Oliveira ◽  
Jaqueline Hack ◽  
Marcela Magro ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Elderly People ◽  
Energy Intake ◽  
Caloric Intake ◽  
Micronutrient Intake ◽  
Increased Risk ◽  
The Relationship

OBJECTIVE: to evaluate the risk of dysphagia and its relationship with the stage of Alzheimer's Disease, as well as the relationship between the risk of dysphagia and nutritional status and caloric intake in elderly people with Alzheimer's disease.METHODS: the sample consisted of 30 subjects of both genders with probable Alzheimer's disease. The stage of the disease, nutritional status, energy intake, and risk of dysphagia were assessed.RESULTS: it was found that increased risk of dysphagia is associated with the advance in the stages of Alzheimer's disease and that even patients in the early stages of disease have a slight risk of developing dysphagia. No association was found between nutritional status and the risk of dysphagia. High levels of inadequate intake of micronutrients were also verified in the patients.CONCLUSION: an association between dysphagia and the development of Alzheimer's disease was found. The results indicate the need to monitor the presence of dysphagia and the micronutrient intake in patients with Alzheimer's disease.

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 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.

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
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