Effect of intensive nutritional counseling and support on clinical outcomes of hemodialysis patients

Molfino, Alessio; Chiappini, Maria Grazia; Laviano, Alessandro; Ammann, Thomas; Bollea, Maria Rosa; Alegiani, Filippo; Fanelli, Filippo Rossi

doi:10.1016/j.nut.2012.01.008

Cited by 25 publications

(18 citation statements)

References 24 publications

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“…Second, the identification of geriatric impairments may guide preventive interventions. For instance, when functional impairment, malnutrition or accidental falling are present, it could ini- tiate rehabilitation, nutritional interventions and fall prevention programs, which could potentially improve health outcomes and/or quality of life [46][47][48][49]. Furthermore, early recognition of cognitive impairment allows for diagnosis and appropriate treatment, education, and psychosocial support.…”

Section: Discussionmentioning

confidence: 99%

Geriatric Assessment in Elderly Patients with End-Stage Kidney Disease

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Loon

Morpey

et al. 2018

Nephron

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Background/Aims: Decision-making in elderly patients considering dialysis is highly complex. With the increasing number of elderly with end-stage kidney disease (ESKD), it may be important to assess geriatric impairments in this population. The aim of the Geriatric assessment in OLder patients starting Dialysis (GOLD) study was to assess the prevalence of geriatric impairments and frailty in the elderly ESKD population by means of a geriatric assessment (GA), which is a comprehensive tool for overall health assessment. Methods: This study included 285 patients ≥65 years: 196 patients at the time of dialysis initiation and 89 patients who chose maximal conservative management (MCM). The GA assessed cognition, mood, nutritional status, (instrumental) activities of daily living (ADL), mobility, comorbidity burden, quality of life and overall frailty. Results: The mean age of the participants was 78 years and 36% were women. Of the incident dialysis patients, 77% started haemodialysis and 23% started peritoneal dialysis. Geriatric impairments were highly prevalent in both dialysis and MCM patients. Most frequently impaired geriatric domains in the dialysis group were functional performance (ADL 29%, instrumental ADL (iADL) 79%), cognition (67%) and comorbidity (41%). According to the GA, 77% in the dialysis group and 88% in the MCM group had 2 or more geriatric impairments. In the MCM group, functional impairment (ADL 45%, iADL 85%) was highly prevalent. Conclusions: Geriatric impairments are highly prevalent in the elderly ESKD population. Since impairments can be missed when not searched for in regular (pre)dialysis care, the first step of improving nephrologic care is awareness of the extensiveness of geriatric impairment.

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Section: Discussionmentioning

confidence: 99%

Geriatric Assessment in Elderly Patients with End-Stage Kidney Disease

Goto

Loon

Morpey

et al. 2018

Nephron

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“…Albumin is well recognized as a strong predictor of death in these patients and as it correlates with inflammation and other negative conditions, it is considered a marker of illness rather than nutrition. 25,26 In fact, some authors propose nutritional counseling to improve albumin 19 while others do not find any changes in this parameter after nutritional intervention, linking this situation to the multiple comorbid conditions that limit the patient's nutritional intake. 7 The decrease in the number of patients with LTI within desirable values (Table 2), observed at the third and sixth months, supports the fact that HD is associated with muscle and whole-body protein losses.…”

Section: Nutritional Counseling In Hemodialysismentioning

confidence: 99%

“…16,17 Nutritionists and dietitians are considered important parts of the dialysis team, providing nutritional counseling and following the effects of dietetic recommendations on nutritional status and medical conditions of dialysis patients. [18][19][20] Dietary advice in HD patients is recommended by the European Best Practice Guidelines on Nutrition as well as by the Kidney Disease Outcomes Quality Iniciative, through a nutritional care plan and individualized dietary counseling, 2,21 which promotes an accurate selection of food options.…”

Section: Introductionmentioning

confidence: 99%

Effect of personalized nutritional counseling in maintenance hemodialysis patients

Garagarza¹,

Valente²,

Oliveira³

et al. 2015

Hemodialysis International

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Monitoring nutritional parameters is an integral part of hemodialysis (HD) patient treatment program. The purpose of this study was to evaluate the impact of the personalized nutritional counseling (PNC) on calcium-phosphorus metabolism, potassium, albumin, protein intake, interdialytic weight gain (IDWG), body composition parameters and fluid overload in HD patients. This was a multicenter longitudinal intervention study with 6 months of follow-up and 731 patients on maintenance HD from 34 dialysis units in Portugal were enrolled. Biochemical and body composition parameters were measured at baseline, 1, 3 and 6 months after the PNC. Patient's mean age was 64.9 (95% confidence interval [CI]: 63.8-66.0) years and mean HD time was 59.8 (95% CI: 55.3-64.3) months. Regarding data comparison collected before PNC vs. 6 months after, we obtained, respectively, the following results: patients with normalized protein catabolic rate (nPCR) ≥ 1 g/kg/day = 66.5% vs. 73.5% (P = 0.002); potassium > 5.5 mEq/L = 52% vs. 35.8% (P < 0.001); phosphorus between 3.5 and 5.5 mg/dL = 43.2% vs. 52.5% (P < 0.001); calcium/phosphorus (Ca/P) ratio ≤ 50 mg/dL = 73.2 % vs. 81.4% (P < 0.001); albumin ≥ 4.0 g/dL = 54.8% vs. 55% (P = 0.808); presence of relative overhydration = 22.4% vs. 25% (P = 0.283); IDWG > 4.5% = 22.3% vs. 18.2% (P = 0.068). PNC resulted in a significant decrease in the prevalence of hyperkalemia, hypophosphatemia and also showed amelioration in Ca/P ratio, nPCR and an increase in P of hyphosphatemic patients. Our study suggests that dietetic intervention contributes to the improvement of important nutritional parameters in patients receiving hemodialysis treatment.

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“…Aktuelle Ziele ernährungsmedizinischer Maßnahmen sind die Progressionshemmung der Nierenerkrankung, die Senkung des kardiovaskulären Risikos, das Verhindern akuter Komplikationen und die Aufrechterhaltung eines adäquaten Ernährungszustandes [3]. Da [14]. In dieser Studie wurde intensiv gemeinsam mit den Patienten gearbeitet und Rücksicht auf deren individuellen Probleme genommen.…”

Section: Unterstützung Der Krankheitsbewältigung Chronisch Niereninsuunclassified

Ernährungsberatung - Unterstützung der Krankheitsbewältigung chronisch niereninsuffizienter Menschen

Schmitt¹

2017

Dialyse aktuell

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Der Anteil chronisch niereninsuffizienter Menschen, die im Verlauf der Erkrankung dialysepflichtig werden, nimmt zu. Durch eine individuell angepasste Ern?hrung k?nnen die Betroffenen den Krankheitsverlauf entscheidend beeinflussen. Der Kontext zwischen Vermeidung einer Mangelern?hrung und dem Erhalt einer h?chstm?glichen Lebensqualit?t wird in dieser Arbeit dargestellt. Die Ursachen f?r eine Malnutrition bei dieser Patientengruppe werden untersucht. Unterschiedliche Untersuchungsmethoden zur Diagnosestellung einer Mangelern?hrung werden aufgezeigt sowie empfohlene Therapiem?glichkeiten diskutiert. Das Ziel dieser Arbeit ist es, aufzuzeigen, dass Ern?hrungsberatung die Malnutrition verbessern oder gar verhindern kann. Es erfolgt ein Einblick in die Theorie der Ern?hrungsberatung bei chronischer Niereninsuffizienz. Durch gezielte Lebensmittelauswahl erhalten die Patienten die M?glichkeit, ihren Ern?hrungszustand zu beeinflussen. Eiwei?- und energiereiche Lebensmittel stellen dabei eine wichtige Grundlage dar. Ebenso tr?gt ein bewusster Einkauf von Nahrungsmitteln, ohne die Verwendung von Zusatzstoffen und die richtige Medikamenteneinnahme, zur Verbesserung der entscheidenden Blutwerte bei. Neben einer geeigneten Auswahl der Lebensmittel, spielen die Anzahl der Beratungseinheiten, der Zeitpunkt der Beratung und der Berater selbst eine wichtige Rolle. Gemeinsam mit dem Patienten kann so, unter Ber?cksichtigung seiner individuellen W?nsche und Bed?rfnisse, ein erfolgreicher Therapieplan erarbeitet werden.

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Effect of intensive nutritional counseling and support on clinical outcomes of hemodialysis patients

Cited by 25 publications

References 24 publications

Geriatric Assessment in Elderly Patients with End-Stage Kidney Disease

Geriatric Assessment in Elderly Patients with End-Stage Kidney Disease

Effect of personalized nutritional counseling in maintenance hemodialysis patients

Ernährungsberatung - Unterstützung der Krankheitsbewältigung chronisch niereninsuffizienter Menschen

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