Nutrition status andHelicobacter pyloriinfection in patients receiving hemodialysis

Abstract

Chronic kidney disease (CKD) patients receiving hemodialysis (HD) often develop gastrointestinal abnormalities over their long treatment period. In general, prognosis in such patients is poor due to the development of protein-energy wasting (PEW). Therefore, it is important to clarify the etiology of PEW and to establish better strategies to deal with this condition. Chronic Helicobacter pylori (H. pylori) infection in the gastric mucosa has a close association with not only the development of peptic ulcer disease and gastric cancer, but is also associated with abnormal plasma and gastric mucosal ghrelin levels that are seen in malnutrition. It is unclear whether H. pylori infection of the gastric mucosa is directly associated with prognosis in HD patients by affecting ghrelin levels. Recent studies show that the prevalence of H. pylori infection in HD patients is significantly lower than in subjects with normal renal function. In the natural history of H. pylori infection in HD patients, the prevalence of infection decreases as the length of time on HD increases. The severity of gastric mucosal atrophy has been suggested as the major determinant of ghrelin levels in these patients, and eradication therapy of H. pylori improves nutritional status by increasing serum cholinesterase and cholesterol levels, especially in patients with mild-to-moderate gastric mucosal atrophy. Prompt H. pylori eradication to inhibit the progress of gastric atrophy may be required to prevent this decrease in ghrelin levels and subsequent PEW and improve the prognosis of HD patients by improving their nutritional status.

<p><em>Helicobacter pylori</em>, Endoscopic, And Histologic Features Among Kidney Transplant Candidates In Southern Iran</p>

“…The important question is how useful the eradication therapy of H. pylori can be in patients with CKD. In a recent study by Sugimoto et al23 they concluded that, since patients with CKD have a higher risk of gastroduodenal diseases, all hemodialysis patients are advised to use endoscopic examinations and H. pylori eradication therapies. In a study by Hsu et al31 on pre-ESRD patients and matched patients on ESRD, they concluded that early H. pylori eradication has a lower risk of peptic ulcer bleeding in positive H. pylori infection.…”

“…The role of H. pylori eradication therapies in improving the nutritional status of patients with CKD has also been studied. Some studies have shown that infection with H. pylori in CKD patients is associated with malnutrition, and it is recommended that eradication of H. pylori may improve nutritional status 23,32. In a pilot study,32 the effect of H. pylori eradication therapy on nutritional status in H. pylori positive hemodialysis patients was investigated.…”

“…There was no consensus on the type of H. pylori eradication regimen for patients with CKD,23,33–36 but a study by Alimadadi et al37 to investigate the effect of creatinine clearance on H. pylori eradication showed no association between the success rate of H. pylori eradication and renal function. In a study by Seyyed Majidi et al34 CKD patients with positive H. pylori were divided into four groups treated for 2 weeks to evaluate different treatment regimens.…”

Low body cell mass index in hemodialysis patients: Association with clinical parameters and survival

“…This result emphasizes the possible link between PEW and altered immune function and an increased risk of infection, as already mentioned in previous studies. 24,25 The main strengths of the present study are the total number of patients included and the long follow-up period. We also analyzed a sample of patients from several dialysis units located in different geographical areas of the country.…”

Recovery of malnutrition in a patient with severe brain injury outcomes

“…[14] This induces a decrease in serum proteins and causes alterations in nutritional indices, weight loss, and loss of muscle mass. [15]…”