Haemodialysis patients with diabetes eat less than those without: A plea for a permissive diet

Bataille, Stanislas; Landrier, Jean‐François; Astier, Julien; Cado, Sylvie; Sallette, Jérôme; Giaime, Philippe; Sampol, J.; Sichez, Hélène; Ollier, Jacques; Gugliotta, Jean; Serveaux, Marianne; Cohen, Julien; Darmon, Patrice

doi:10.1111/nep.12837

Cited by 14 publications

(13 citation statements)

References 24 publications

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“…And while hypoalbuminemia is more frequently observed among patients with vs. without DM [37], it does not appear to differ between patients with diabetic kidney disease compared to patients with DM as a comorbidity whose renal disease is due to another underlying condition [38]. While there is some disagreement as to the meaning of these findings, investigators have noted that dietary intake is significantly lower in dialysis patients with vs. without DM, suggesting that hypoalbuminemia represents deteriorated nutrition status in these patients [39]. Hypoalbuminemia has long been identified as an independent risk factor for CVD in HD patients [40], though one report identified this association in patients receiving peritoneal dialysis but not in HD patients [41].…”

Section: Discussionmentioning

confidence: 80%

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Boaz

Azoulay

Schwartz

et al. 2019

Nephron

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Background: Malnutrition is a frequently observed disorder in patients with chronic kidney disease (CKD) receiving hemodialysis (HD). While variously defined, malnutrition is a frequently observed condition among patients on HD. Prevalence estimates of malnutrition among Israeli HD patients have not been reported. Objectives: To survey nutrition intake in Israeli HD patients; estimate malnutrition risk prevalence; identify risk factors, and characterize malnutrition risk in HD patients. Methods: A representative sample of 378 Israeli HD patients treated in hospital HD centers throughout the country were surveyed. Using the 24-h recall method, dietary intake was estimated and the chronologically corresponding biochemistry, anthropometric, and hemodynamic measures were recorded. Four categories of malnutrition risk were defined: “minimal”: body mass index (BMI) > 23 kg/m² and serum albumin > 3.8 g/dL; “mild”: BMI < 23 kg/m² and albumin > 3.8 g/dL; “moderate”: BMI > 23 kg/m² and albumin < 3.8 g/dL; “severe”: BMI < 23 k/m² and serum albumin < 3.8 g/dL. Results: Elevated malnutrition risk was identified in 175 (46.3%) study participants, who were more likely to require feeding assistance, have major comorbidities, reduced hemoglobin, and elevated C-reactive protein. Oral nutrition supplementation was prescribed to only 14.3% of patients with elevated malnutrition risk. Intradialytic parenteral nutrition was recorded for 6 patients, all of whom had moderate or severe malnutrition risk. Less than one-third of patients met the guidelines for dietary intake of energy or protein, and this did not differ across malnutrition risk groups. Discussion: Elevated malnutrition risk is a frequent finding in HD patients treated in hospital settings in Israel. Dietary intake does not meet guidelines but does not differ across malnutrition risk categories. Nutrition supplements are underused in HD patients with high malnutrition risk. There is a need to expand the survey to community HD centers.

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Section: Discussionmentioning

confidence: 80%

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Boaz

Azoulay

Schwartz

et al. 2019

Nephron

View full text Add to dashboard Cite

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“…The reasons or consequences of these differences are not known and, as most of the previous studies have quite exclusively focused on the dietary intake when renal deterioration has already progressed into end-stage renal disease, comparing these observations with the previous ones is challenging. In one study assessing dietary intake in haemodialysis, lower intakes of total energy, protein, and calcium were reported in individuals with diabetes compared to those without [18]. Another study of haemodialysis reported higher intakes of total energy, protein, fat, and fibre in men with diabetes compared to men without [19].…”

Section: Discussionmentioning

confidence: 99%

Dietary intake in type 1 diabetes at different stages of diabetic kidney disease

Ahola

Forsblom

Groop

2019

Diabetes Research and Clinical Practice

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Diet plays an important role in the kidney health of individuals with type 1 diabetes. However, not much is known about dietary practices at different stages of diabetic nephropathy. We aimed at investigating food intake, dietary patterns, and nutrient intakes in individuals with type 1 diabetes differing in renal status. Methods: Data were available from 1874 individuals with type 1 diabetes (45% men, age 48 ± 13 years). Diet was assessed at the levels of food items and diet patterns (diet questionnaire), and energy and nutrient intakes (food record). Six groups were formed based on the eGFR or dialysis and transplantation status. Results: Reductions in liquid-milk product and salt consumption, and increase in special diet adherence were observed at the early stages of eGFR decline. Reduced coffee consumption was observed after eGFR was <30 ml/min/1.73 m 2. With advancing kidney failure, rye bread consumption decreased, but that of wheat bread increased. Compared to those with intact kidney function (the index group), the Fish and vegetable diet pattern scores were higher in individuals with mildly-to-severely decreased eGFR. Instead, the Sweet pattern scores were lower than in the index group in all other groups. Energy intake was lower in all groups compared to those with intact kidney function. Advancing kidney failure was associated with reductions in protein intake per body weight, and in the intakes of sodium, potassium, calcium, and phosphorus. Conclusions: Differences in the dietary intake are seen already at the early stages of kidney function decline.

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“…Diabetologists, nephrologists, and nutritionists should be involved in treating patients with DMCKD who are getting worse, because the exact assessments of the nutritional status of those patients and the proper nutritional interventions for those patients are never easy and simple [14]. Most importantly, dietary advice should be tailored to the individual and the stage of DMCKD.…”

Section: Discussionmentioning

confidence: 99%

Decreased Bioimpedance Phase Angle in Patients with Diabetic Chronic Kidney Disease Stage 5

et al. 2019

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Early detection and regular monitoring of the nutritional status of patients with diabetic chronic kidney disease (DMCKD) with reliable tools are necessary. We aimed to determine the clinical significance of the phase angle (PhA) in patients with DMCKD stage 5 not undergoing dialysis. A total of 219 patients (non-diabetic CKD stage 5 [nDMCKD5], n = 84; diabetic CKD stage 5 [DMCKD5], n = 135) were analyzed. The nDMCKD5 group had a significantly higher PhA (p = 0.001), intracellular water/body weight (p = 0.001), and albumin level (p = 0.010) than the DMCKD5 group. The DMCKD5 group experienced significantly more overhydration (p < 0.001). The PhA was positively associated with the lean tissue index (LTI) (r = 0.332; p < 0.001), hemoglobin level (r = 0.223; p = 0.010), albumin level (r = 0.524; p < 0.001), and estimated glomerular filtration rate (eGFR; r = 0.204; p = 0.018) in the DMCKD5 group. Multivariate logistic regression analysis showed the eGFR (odds ratio [OR]: 0.824, 95% confidence interval [CI]: 0.698–0.974); p = 0.023), LTI (OR: 0.771, 95% CI: 0.642–0.926; p = 0.005), and albumin level (OR: 0.131, 95% CI: 0.051–0.338; p < 0.001) were significantly associated with undernutrition (PhA < 4.17°) in the DMCKD5 group. Our observations suggest that the PhA could be used as a marker to reflect the nutritional status in patients with DMCKD5.

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Haemodialysis patients with diabetes eat less than those without: A plea for a permissive diet

Abstract: Diabetes is an important factor associated with low dietary intake in haemodialysis patients. Restrictive regimens should be prescribed cautiously in haemodialysis patients, especially in those with diabetes.

Cited by 14 publications

References 24 publications

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Dietary intake in type 1 diabetes at different stages of diabetic kidney disease

Decreased Bioimpedance Phase Angle in Patients with Diabetic Chronic Kidney Disease Stage 5

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