A paradoxical increase in resting energy expenditure in malnourished patients near death: the king penguin syndrome

Rigaud, Daniel; Hassid, J.; Meulemans, A.; Poupard, Anne Thérèse; Boulier, Audrey

doi:10.1093/ajcn/72.2.355

Cited by 80 publications

(74 citation statements)

References 22 publications

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“…40 -42 It has been indicated that albumin levels remain virtually unchanged under conditions of severe protein-energy malnutrition in otherwise healthy individuals until near terminal starvation. 43 In addition, to be used as a nutritional marker, albumin is well established as a strong predictor of outcome in dialysis patients. 44,45 Furthermore, Rocco et al 46 recently showed that failure to meet the treatment goal recommended by the National Kidney Foundation of albumin levels Ͼ40 g/L is associated with poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Growth Hormone Treatment during Hemodialysis in a Randomized Trial Improves Nutrition, Quality of Life, and Cardiovascular Risk

Feldt‐Rasmussen

Lange

Sułowicz

et al. 2007

Journal of the American Society of Nephrology

103

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Nutritional markers, such as lean body mass (LBM) and serum albumin, predict outcome in dialysis patients, in whom protein-energy malnutrition is associated with increased morbidity and mortality. The metabolic effects of human growth hormone (hGH) may improve the nutritional and cardiovascular health of these patients and consequently reduce morbidity and mortality. The aim of this study was to establish clinical proof of concept of hGH treatment for the improvement of the nutritional status in adult patients who are on maintenance hemodialysis. A total of 139 adult patients who were on maintenance hemodialysis and had serum albumin levels Յ40 g/L were randomly assigned to 6 mo of treatment with placebo or 20, 35, or 50 g/kg per d hGH. Change in LBM and serum albumin (primary outcomes), health-related quality of life, and secondary efficacy and safety parameters were monitored. The study showed that hGH treatment increased LBM significantly at all dosage levels (2.5 kg [95% confidence interval 1.8 to 3.1] versus Ϫ0.4 kg [95% confidence interval Ϫ1.4 to 0.6]; P Ͻ 0.001 for pooled hGH groups versus placebo). Serum albumin tended to increase (P ϭ 0.076), serum transferrin (P ϭ 0.001) and serum HDL (P Ͻ 0.038) increased, and plasma homocysteine was reduced (P ϭ 0.029). TNF-␣ also tended to decrease with treatment (P ϭ 0.134). An improvement in the Role Physical SF-36 quality-of-life subscale was observed (P ϭ 0.042). There were no differences in clinically relevant adverse events between groups. In conclusion, hGH therapy safely improves LBM, other markers of mortality and morbidity, and health-related quality of life in adult patients who are on maintenance hemodialysis. A long-term study is warranted to investigate whether these treatment benefits result in reduced mortality and morbidity.

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Section: Discussionmentioning

confidence: 99%

Growth Hormone Treatment during Hemodialysis in a Randomized Trial Improves Nutrition, Quality of Life, and Cardiovascular Risk

Feldt‐Rasmussen

Lange

Sułowicz

et al. 2007

Journal of the American Society of Nephrology

103

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“…33 These patients maintain serum albumin levels in the normal range, even when BMIs reach the low teens. [33][34][35][36] Only when health status approaches death does serum albumin actually fall. 34 Additional insights are gleaned from the Minnesota Experiment.…”

Section: Serum Albumin and Malnutrition In The General Populationmentioning

confidence: 99%

“…[33][34][35][36] Only when health status approaches death does serum albumin actually fall. 34 Additional insights are gleaned from the Minnesota Experiment. 37 Initiated in the early 1940s by Ancel Keys, this seminal study explored the biology and physiology of human starvation.…”

Section: Serum Albumin and Malnutrition In The General Populationmentioning

confidence: 99%

Reassessment of Albumin as a Nutritional Marker in Kidney Disease

Friedman¹,

Fadem

2010

Journal of the American Society of Nephrology

315

245

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“…Although protein calorie malnutrition alone may be associated with hypoalbuminemia, in otherwise healthy individuals, serum albumin concentration does not decline until starvation is preterminal (64). Albumin concentration decreases in dialysis patients primarily as a consequence of increased inflammation with a subsequent decline in the rate of albumin synthesis (62) coupled with a failure to downregulate albumin catabolism as occurs during protein restriction.…”

Section: Hypoalbuminemiamentioning

confidence: 99%

Biochemistry and Biomarkers of Inflamed Patients

Kaysen

2009

Clinical Journal of the American Society of Nephrology

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Specific laboratory tests and physical findings are available to the practicing clinician that should raise the suspicion of inflammation. Inflammation is related to specific clinical outcomes. Once identified, changes in clinical practice may affect the level of inflammation in individual and or groups of dialysis patients with the hope that these changes may in turn affect outcome in a positive manner. Standard clinical tests and observations associated with inflammation are hypoalbuminemia, erythropoietin resistance, decreased iron saturation accompanied by high ferritin, frailty, low serum creatinine, reduced total and LDL-cholesterol, and increased C reactive protein (CRP). Inflammation is strongly associated with loss of physical function, dyslipidemia (low LDL-and HDL-cholesterol, increased triglycerides), and anemia that is unresponsive to erythropoietin. Inflammation is associated with cardiovascular events, increased hospitalization, and death. Correctible causes of inflammation are tunneled dialysis catheters, arteriovenous grafts, catheter infection, periodontal disease, poor water quality, and dialyzer incompatibility. Obesity also is a source of cytokines but may be less amenable to treatment. Inflammation is multifactorial in dialysis patients. Some sources are recognizable and correctable, such as vascular access type, clinical infection, and water quality, and some are not. Inflammation is strongly associated with outcome.

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A paradoxical increase in resting energy expenditure in malnourished patients near death: the king penguin syndrome

Abstract: In malnourished persons near death, there is an increase in REE and in protein catabolism. The reason for this increase is unknown but could relate to consumption of the last mobilizable muscle mass and to diseased cellular membranes.

Cited by 80 publications

References 22 publications

Growth Hormone Treatment during Hemodialysis in a Randomized Trial Improves Nutrition, Quality of Life, and Cardiovascular Risk

Growth Hormone Treatment during Hemodialysis in a Randomized Trial Improves Nutrition, Quality of Life, and Cardiovascular Risk

Reassessment of Albumin as a Nutritional Marker in Kidney Disease

Biochemistry and Biomarkers of Inflamed Patients

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