Nutritional status of older patients on hemodialysis: Which nutritional markers can best predict clinical outcomes?

Rodrigues, Juliana; Santin, Fernanda; Brito, Flávia dos Santos Barbosa; Lindholm, Bengt; Stenvinkel, Peter; Avesani, Carla María

doi:10.1016/j.nut.2019.03.002

Cited by 36 publications

(37 citation statements)

References 35 publications

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“…Therefore, the patients included in the sensory analysis would show more benefit from food initiatives with increased energy and protein amounts. As is well-known and has been demonstrated, malnutrition is highly associated with poor quality of life [23,24], increased hospitalization rates [24,25] and higher all-case and cardiovascular mortality [24][25][26][27][28][29][30] Since increasing energy and protein intake is a recognized approach to treating malnutrition, strategies as the one from the current study are relevant for the clinical practice of dietitians working with end-stage kidney disease (ESKD) patients, especially because industrialized supplements are not always feasible for all patients in dialysis centers. This result shows the importance of developing food products that can increase the options of intradialytic supplementation and that match with the patient's food preferences.…”

Section: Discussionmentioning

confidence: 99%

Development of muffins as dialysis snacks for patients undergoing hemodialysis: results of chemical composition and sensory analysis

et al. 2020

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Objective This study aimed to develop two non-industrial food products as financially accessible options to prevent and treat malnutrition in hemodialysis (HD) patients. These food products were developed and intended for use as dialysis snacks. Methods This is a cross-sectional and multi-step study. First, 183 adult HD patients (55 ± 14 years; 50.8% males), replied to a questionnaire with their food preferences regarding taste (salty, sweet, bitter, sour) and consistency (liquid, solid, pasty) for a dialysis snack. Most patients preferred a food product with a solid consistency (90%) and a salty flavor (81.4%). Second, three muffin formulations of fine herbs were developed; one enriched with whey protein concentrate (WPC), a second with textured soy protein (TSP) and a third standard formulation without protein for comparison with the protein-enriched muffins, for which the chemical and nutritional compositions were analyzed. In the third step, 60 patients on HD (61 ± 15 years; 53% males) were enrolled in a sensory analysis by applying a 9-point structured hedonic scale, ranging from "extremely liked" (score 9) to "extremely disliked" (score 1). Results When compared with the standard formulation, the formulations enriched with WPC and TSP protein had a significantly higher amount of protein/serving (Standard: 5.9 ± 0.3 g vs WPC: 14.5 ± 0.9 g and TSP 10.8 ± 0.7 g; P < 0.05) but a lower amount of carbohydrate (Standard: 13.1 ± 2.2 g vs WPC: 5.6 ± 0.8 g and TSP 6.0 ± 1.2 g vs; P < 0.05). The mineral content/serving of the protein-enriched muffins was low in phosphorus (50 mg) and sodium (180 mg). The potassium content/ serving was moderate for the WPC muffin (225.2 mg) and low for the TSP muffin (107.9 mg). The acceptability index (AI) for the enriched protein muffins was higher than 70% and similar to the standard formulation. Conclusion The muffins with fine herbs and enriched with protein were well-accepted by all patients and appropriate to serve as dialysis snacks for HD patients.

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Section: Discussionmentioning

confidence: 99%

Development of muffins as dialysis snacks for patients undergoing hemodialysis: results of chemical composition and sensory analysis

et al. 2020

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“…Our cutoffs for mid arm muscle circumference and CC differed from both studies, showing that cutoffs are population-specific. Adding more importance to the measurement, CC was shown to predict worse clinical outcomes in HD patients [38].…”

Section: Plos Onementioning

confidence: 99%

Bed-side measures for diagnosis of low muscle mass, sarcopenia, obesity, and sarcopenic obesity in patients with chronic kidney disease under non-dialysis-dependent, dialysis dependent and kidney transplant therapy

et al. 2020

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Muscle depletion and sarcopenic obesity are related to a higher morbimortality risk in chronic kidney disease (CKD). We evaluated bed-side measures/indexes associated with low muscle mass, sarcopenia, obesity, and sarcopenic obesity in CKD and proposed cutoffs for each parameter. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People revised consensus applying dual energy X-ray absorptiometry (DXA) and hand grip strength (HGS), and obesity according to the International Society for Clinical Densitometry. Anthropometric parameters including calf (CC) and waist (WC) circumferences and WC/height (WC/H); bioelectrical impedance data including appendicular fat free mass (AFFM) and fat mass index (FMI) were assessed. ROC analysis and area under the curve (AUC) were applied for performance analyses. AFFM and CC presented the best performances for low muscle mass diagnosis–AFFM AUC for women was 0.96 and for men, 0.94, and CC AUC for women was 0.89 and for men, 0.85. FMI and WC/H were the best parameters for obesity diagnosis–FMI AUC for women was 0.99 and for men, 0.96, and WC/H AUC for women was 0.94 and for men, 0.95. The cutoffs (sensibility and specificity, respectively) for women were AFFM≤15.87 (90%; 96%), CC≤35.5 (76%; 94%), FMI>12.58 (100%; 93%), and WC/H>0.66 (91%; 84%); and for men, AFFM≤21.43 (98%; 84%), CC≤37 (88%; 69%), FMI>8.82 (93%; 88%), and WC/H>0.60 (95%; 80%). Sensibility and specificity for sarcopenia diagnosis were for AFFM+HGS in women 85% and 99% and in men, 100% and 99%; for CC+HGS in women 85% and 99% and in men, 100% and 100%; and for sarcopenic obesity were for FMI+AFFM in women 75% and 97% and in men, 75% and 95%. The tested bed-side measures/indexes presented excellent performance.

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“…www.nature.com/scientificreports www.nature.com/scientificreports/ Subgroup analysis showed that the association between increased albumin-corrected serum calcium level and heightened infection-related mortality was enhanced in patients with lower serum albumin level and in younger patients. Because malnutrition was shown to be a strong inducer and predictor of infection 36 , it is reasonable that hypercalcemic patients with lower albumin level were at heightened risk of infection than those without hypoalbuminemia. Regarding the effect modification by age, it is unclear why the association between hypercalcemia and increased risk of infection-related death was enhanced in younger patients.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Infection-Related and All-Cause Death in Hypercalcemic Patients Receiving Hemodialysis: The Q-Cohort Study

Yamada

Arase

Tokumoto

et al. 2020

Sci Rep

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Although hypercalcemia is a risk factor for all-cause mortality in hemodialysis patients, it remains unknown whether hypercalcemia increases the risk of infection-related death. A total of 2869 hemodialysis patients registered in the Q-cohort Study, a multicenter, prospective cohort study of hemodialysis patients, were analyzed. the predictor was albumin-corrected serum calcium level at baseline. the main outcome was infection-related death. Death risk were estimated by multivariableadjusted cox proportional hazard risk models and competing risk models. During the follow-up period of 4 years, 107 patients died of infection and 473 died of any cause. The patients were divided into four groups by the serum calcium level at baseline (G1, 5.7-8.9 mg/dL; G2, 9.0-9.4 mg/dL; G3, 9.5-9.9 mg/L; G4 10.0-16.5 mg/dL). In the multivariable-adjusted model, the incidence of infection-related death was significantly higher in the highest serum calcium group (G4) compared with the lowest serum calcium group (G1): hazard ratio [95% confidence interval], 2.34 [1.35-4.04], P = 0.002. Furthermore, higher serum calcium level was significantly associated with increased risk of all-cause death. In conclusion, our data suggest that a higher serum calcium level may be a risk factor for infection-related and all-cause death in hemodialysis patients.

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Nutritional status of older patients on hemodialysis: Which nutritional markers can best predict clinical outcomes?

Cited by 36 publications

References 35 publications

Development of muffins as dialysis snacks for patients undergoing hemodialysis: results of chemical composition and sensory analysis

Development of muffins as dialysis snacks for patients undergoing hemodialysis: results of chemical composition and sensory analysis

Bed-side measures for diagnosis of low muscle mass, sarcopenia, obesity, and sarcopenic obesity in patients with chronic kidney disease under non-dialysis-dependent, dialysis dependent and kidney transplant therapy

Increased Risk of Infection-Related and All-Cause Death in Hypercalcemic Patients Receiving Hemodialysis: The Q-Cohort Study

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