Association between nutritional, inflammatory and oxidative status (NIOS) and risk of adverse outcomes in patients on haemodialysis (HD): the NIOS-HD prospective cohort study protocol

Abstract

IntroductionThe mortality of patients on chronic haemodialysis is 10–30 times greater than that of the general population and over 60% of these individuals die within the first 5 years of beginning haemodialysis. Although causes for excessive mortality in haemodialysis patients are not clearly defined, it seems that nutrition, inflammation and oxidative stress play key roles in this regard. Until now, no cohort study has focused on the association between nutritional, inflammatory or oxidative status and risk of complications and adverse outcomes in Iranian haemodialysis patients. Therefore, we sought to fill this gap and designed the Nutritional, Inflammatory, and Oxidative Status in Hemodialysis (NIOS-HD) prospective cohort study to determine the association of dietary factors, malnutrition, anthropometric indices, body composition, inflammation and oxidative stress with quality of life, dialysis access infections, hospitalisation, potential years of life lost and mortality in adults on maintenance haemodialysis in Isfahan, Iran.Methods and analysisThe sample size of this cohort was estimated to be 300 participants. At baseline, demographic, medical and dialysis-related data of eligible patients will be recorded. In addition, participants will undergo anthropometric measurements, malnutrition assessment and body composition analysis. Also, their dietary intake and quality of life will be evaluated through interviewer-administered questionnaires. Moreover, their fasting blood samples will be collected and stored for biochemical assays including transthyretin, albumin, serum amyloid A, pentraxin-3, trimethylamine N-oxide, myeloperoxidase, paraoxonase-1 and superoxide dismutase. After baseline evaluation, patients will be followed up to 3 years to update exposure information (except biochemical assays) and measure adverse outcomes. Finally, collected data will be analysed using descriptive and inferential statistics.Ethics and disseminationThe NIOS-HD is in agreement with the Declaration of Helsinki and has been approved by the Ethics Committee of Isfahan University of Medical Sciences (reference number: IR.MUI.RESEARCH.REC.1399.605). Findings of this study will be published in academic journals.

Intradialytic parenteral nutrition in malnourished patients with chronic kidney disease: a systematic review

“…This denotes the real need for more research involving this group of patients and this type of intervention. New research addressing outcomes in patients with CKD according to a set of variables that assess nutritional, inflammatory, and oxidative status is being improved [18]. Despite the heterogeneity found in the types of formulas administered by the different articles during the IPN intervention, effects on albumin and prealbumin levels were identified.…”

Pentraxin 3 in Kidney Disease and Renal Replacement Therapies

“…According to its possible role as biomarker, PTX3 is pointed out as the most sensitive inflammatory predictor of all-cause mortality after adjustment for the main confounding factors in HD patients [116] even according to nutritional, inflammatory and oxidative status [117].…”

Malnutrition and Erythropoietin Resistance among Patients with End-Stage Kidney Disease: Where Is the Perpetrator of Disaster?

“…Malnutrition is a significant and growing problem among patients treated with hemodialysis, affecting 23-60% of individuals [1][2][3]. It is linked not only with increased mortality, but also with substantial decrease in quality of life as well [4,5]. Despite technological development giving clinicians better tools to assess nutritional status, such as professional body composition analyzers, proper instruments and interventions to impede the burden of undernourishment in this population are still not well established.…”