Expert Working Group report on nutrition in adult patients with renal insufficiency (part 1 of 2)

Toigo, G.; Aparicio, Michel; Attman, Per‐Ola; Cano, Noël; Cianciaruso, Bruno; Engel, Barbara; Fouque, Denis; Heidland, A.; Teplan, Vladimı́r; Wanner, Christoph

doi:10.1054/clnu.1999.0130

Cited by 97 publications

(68 citation statements)

References 95 publications

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“…34 PEW affects approximately 40% of patients at the initiation of dialysis 35 and is linked to increased morbidity and mortality during maintenance dialysis. 36 Although pathogenesis of PEW in uremia is multifactorial, low nutrient intake, reduced protein synthesis, and increased protein catabolism play the dominant role.…”

Section: Discussionmentioning

confidence: 99%

Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status

Brito-Ashurst

Varagunam

Raftery

et al. 2009

Journal of the American Society of Nephrology

749

573

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Bicarbonate supplementation preserves renal function in experimental chronic kidney disease (CKD), but whether the same benefit occurs in humans is unknown. Here, we randomly assigned 134 adult patients with CKD (creatinine clearance [CrCl] 15 to 30 ml/min per 1.73 m 2 ) and serum bicarbonate 16 to 20 mmol/L to either supplementation with oral sodium bicarbonate or standard care for 2 yr. The primary end points were rate of CrCl decline, the proportion of patients with rapid decline of CrCl (Ͼ3 ml/min per 1.73 m 2 /yr), and ESRD (CrCl Ͻ10 ml/min). Secondary end points were dietary protein intake, normalized protein nitrogen appearance, serum albumin, and mid-arm muscle circumference. Compared with the control group, decline in CrCl was slower with bicarbonate supplementation (5.93 versus 1.88 ml/min 1.73 m 2 ; P Ͻ 0.0001). Patients supplemented with bicarbonate were significantly less likely to experience rapid progression (9 versus 45%; relative risk 0.15; 95% confidence interval 0.06 to 0.40; P Ͻ 0.0001). Similarly, fewer patients supplemented with bicarbonate developed ESRD (6.5 versus 33%; relative risk 0.13; 95% confidence interval 0.04 to 0.40; P Ͻ 0.001). Nutritional parameters improved significantly with bicarbonate supplementation, which was well tolerated. This study demonstrates that bicarbonate supplementation slows the rate of progression of renal failure to ESRD and improves nutritional status among patients with CKD.

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Section: Discussionmentioning

confidence: 99%

Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status

Brito-Ashurst

Varagunam

Raftery

et al. 2009

Journal of the American Society of Nephrology

749

573

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“…[7] Common causes of malnutrition in CRF are decreased food intake, metabolic acidosis, increased serum leptin levels, hyperparathyroidism, insulin resistance, growth factor deficiency, dialysisrelated nutrient loss, and membrane bioincompatibility. [8] The prevalence of inflammation is very high (30-50%) in ESRD patients, and chronic inflammatory state may cause hypoalbuminemia in these patients. [9,10] The metabolism of serum albumin has been adversely hampered in patients with CRF, and these include the redistribution of albumin into the interstitium, decreased synthesis, and external loss of albumin.…”

Section: Introductionmentioning

confidence: 99%

“…[11] Protein catabolism is further increased in patients undergoing hemodialysis with bioincompatible membranes. [8] Currently, several approaches (e.g., clinical evaluation, anthropometric measurements, biophysical and biochemical methods) have been used to assess nutrition. Serum albumin is probably still the most commonly used nutritional marker in chronic renal failure patients and is also a marker of inflammation (negative correlation) in these patients.…”

Section: Introductionmentioning

confidence: 99%

High Prevalence of Malnutrition and Inflammation in Undialyzed Patients with Chronic Renal Failure in Developing Countries: A Single Center Experience from Eastern India

et al. 2007

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Background. Malnutrition is common in patients with chronic renal failure (CRF), and its prevalence before the initiation of dialysis is poorly characterized in these patients in developing countries. There is a paucity of data on the quantification of malnutrition and inflammation in undialyzed patients of CRF from India. This study analyzed the prevalence and causes of malnutrition in patients with CRF before the initiation of dialysis treatment. Material and Methods. In the present study, assessments of nutritional and inflammatory status were carried out in patients with CRF. Serum albumin, body mass index (BMI), triceps skin fold thickness (TST), mid-arm muscle circumference (MAMC), and subjective global assessment (SGA) scoring were used for assessment of nutritional parameters. Serum C-reactive protein and serum ferritin level were used to assess the inflammatory state of the patient. Results. Two hundred and three (146 male, 57 female) patients with CRF were included in the study from August 2004 to April 2006. Overall, the prevalence of malnutrition was 65% (131/203). The age of malnourished patients (93 male, 38 female) ranged from 11-82, with mean age of 52 ± 12.68 years. The mean serum total protein and albumin were also significantly lower in patients with malnutrition in comparison to non malnourished cases (5.50 ± 0.40 gm/dL vs. 5.74 ± 0.38 gm/dL; p < 0.05, and 3.18 ± 0.58 gm/dL vs. 3.68 ± 0.55 gm/dL; p < 0.05). The C-reactive protein and serum ferritin were significantly elevated in the malnourished group as compared to non-malnourished patients (63% vs. 33%; p < 0.05, and 301.2 ± 127.1 mg/dL vs. 212.7 ± 124.9 mg/dL; p < 0.05). Conclusion. Thus, malnutrition was common in patients with CRF before the commencement of dialysis. These data indicate that an emphasis should be placed on the assessment and prevention or correction of malnutrition in patients with CRF because of its documented adverse effect on the outcome on maintenance dialysis.

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“…There is a high prevalence of malnutrition and negative nitrogen balance in CKD patients because of several factors such as the decreased protein and energy intake due to protein restriction and low-phosphorus diet, the presence of anorexia, which is related to uremic toxins, the impaired gastrointestinal motility, medicines, and taste disturbances, psychological factors (depression), endocrine and metabolic disorders and concurrent chronic illnesses [12,14].…”

Section: Discussionmentioning

confidence: 99%

Effects of Parenteral Infusion of Amino Acid Solutions in Acid-Base Balance in Patients with Advanced Chronic Renal Failure

Kalogiannidou¹

2012

J Nephrol Therapeutic

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Malnutrition is a very common condition in patients with chronic kidney disease (CKD), especially after the 3 rd stage (GFR 30-59 mL/min/1.73 m 2 ). It affects virtually every organ and the function of the entire organism as well and therefore influences the survival. Moreover, the supplementation of amino acids could correct the negative nitrogen balance of those patients improving their survival rates, while little is known regarding any possible negative effect of this supplementation of amino acids on the acid-base balance.We investigated the impact of parenteral infusion of two different kinds of amino acid solutions (specific for CKD patients and nonspecific) in 25 patients (12F, 13M), suffered from chronic renal failure in stages 3 and 4 (GFR 16 to 45.1 mL/min/1.73 m 2 ). The specific for uremic CKD patients solution A was administrated for 5 days, and after an interval of one week, we treated the same patients for another 5 days with the second non-specific solution B, with usual composition), in order to investigate their influence on patients' acid-base balance. Comparing the results of the first and the last infusion of solution A, neither pH nor blood gases analysis presented significant differences, while solution B induced statistically significant changes in both pH and blood gases, (p=0.0001). Acidosis was resulted in by the reduction of serum levels of HCO 3 -whereas not any significant change observed in serum lactate levels after the infusion of each solution.These results suggest that for patients with chronic kidney disease in stages 3 and 4 who require the administration of a supplementary amino acid solution, the CKD-specific solution A may be preferred, since it prevents the worsen of the metabolic acidosis, which is commonly present in these patients.

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Expert Working Group report on nutrition in adult patients with renal insufficiency (part 1 of 2)

Cited by 97 publications

References 95 publications

Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status

Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status

High Prevalence of Malnutrition and Inflammation in Undialyzed Patients with Chronic Renal Failure in Developing Countries: A Single Center Experience from Eastern India

Effects of Parenteral Infusion of Amino Acid Solutions in Acid-Base Balance in Patients with Advanced Chronic Renal Failure

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