Protein Nutrition and Malnutrition in CKD and  ESRD

Zha, Yan; Qian, Qi

doi:10.3390/nu9030208

Cited by 213 publications

(181 citation statements)

References 170 publications

(181 reference statements)

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“…M ALNUTRITION IS COMMON in patients on maintenance hemodialysis (MHD) and contributes to increased morbidity and mortality. 1,2 The etiology of malnutrition is complex and multifactorial. Suboptimal nutritional intake is common in these patients and poses a direct risk of protein malnutrition.…”

Section: Introductionmentioning

confidence: 99%

A Low-Cost, Intradialytic, Protein-Rich Meal Improves the Nutritional Status in Chinese Hemodialysis Patients

Hou

Sun

et al. 2020

Journal of Renal Nutrition

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Short-term administration of oral nutritional supplements can improve the nutritional status of hemodialysis patients. However, such treatment is associated with high cost. The aim of the present trial was to evaluate the benefits of the short-term administration of a low-cost, intradialytic, protein-rich meal on selected parameters of the nutritional status in Chinese patients undergoing hemodialysis. Methods: This was a 6-month single-center, prospective interventional study. Stable hemodialysis patients aged $18 years with a concentration of serum albumin ,40 g/L were eligible for inclusion in this study. Patients allocated to the intervention group (IG) received nutritional counseling plus a low-cost, intradialytic, protein-rich meal thrice weekly over a period of 3 months, followed by a treatment-free period of 3 months. Patients allocated to the control group (CG) received nutritional counseling alone. Changes in serum albumin and body composition were investigated. Results: At the start of the study, both groups were similar except for the levels of C-reactive protein (P 5 .034) and hemoglobin (P 5 .003). At the end of the study period, the level of serum albumin (P 5 .001) was significantly increased with increased protein intake in the IG (P 5 .048). However, this difference was not sustained during the follow-up period after termination of therapy. In the IG, the levels of serum albumin were significantly decreased between months 3 and 6 (P , .001), whereas those in the CG remained unchanged. There were no statistically significant differences observed between the two groups in the levels of C-reactive protein and body composition. Conclusion: The short-term administration of a low-cost, intradialytic, protein-rich meal (i.e., 200 mL milk plus two egg whites) resulted in a significant improvement in the levels of serum albumin versus nutritional counseling alone. This inexpensive nutritional intervention was feasible for the treatment of Chinese patients undergoing hemodialysis.

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Section: Introductionmentioning

confidence: 99%

A Low-Cost, Intradialytic, Protein-Rich Meal Improves the Nutritional Status in Chinese Hemodialysis Patients

Hou

Sun

et al. 2020

Journal of Renal Nutrition

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“…17,18 T2D patients with diabetic nephropathy/ chronic kidney disease (CKD) may follow a diet with decreased protein intake as part of their disease management and on the other hand, CKD associates with elevated protein catabolism and protein malnutrition. 19,20 Another observation in this analysis was that malnutrition was present even in patients with obesity. Usually, malnutrition is associated with underweight/weight loss, but certain features of malnutrition can occur even in subjects with higher BMI.…”

Section: Discussionmentioning

confidence: 77%

Malnutrition and Metabolic Changes in Patients with Type 2 Diabetes

Roiban

Both²

2018

Journal of Interdisciplinary Medicine

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Background/Aim: In patients with type 2 diabetes (T2D), malnutrition has been recognized as a serious health problem mainly in hospitalized conditions, but there is little data regarding malnutrition outside hospital settings. The aim of this study was to evaluate the risk of malnutrition and associated metabolic changes in ambulatory patients with T2D. Material and methods: This analysis used data collected from 161 patients with T2D enrolled in a larger crosssectional study. Several anthropometric and metabolic parameters were obtained. Nutritional status was evaluated using the Controlling Nutritional Status (CONUT) score. Correlations between nutritional status and metabolic and anthropometric parameters of interest were examined. Results: Of all T2D patients, 29.8% had mild malnutrition (CONUT score 2-4). These patients presented lower triglyceride (124.8 ± 42.3 mg/dL vs. 165.7 ± 84.3 mg/dL, p <0.01) and LDL cholesterol concentrations (62.7 ± 20.0 mg/dL vs. 104.9 ± 30.6 mg/dL, p <0.0001), higher leptin levels (10.2 [1.6-44.9] ng/mL vs. 7.3 [0.9-49.8] ng/mL, p <0.05) and free leptin index (0.65 [0.04-2.88] vs. 0.36 [0.01-3.98], p <0.05) compared with patients with normal nutritional status. They also had higher total body adiposity. In patients with obesity, triglycerides levels were lower in those with mild malnutrition vs. those without malnutrition (mean difference: 27.26 mg/ dL, p <0.05). Serum C peptide/leptin ratio was higher in T2D patients with normal nutritional status without obesity, the differences being significant vs. the two groups with obesity (with or without malnutrition, 0.71 ± 0.53, 0.42 ± 0.33, and 0.49 ± 0.68, respectively). HOMA-IR was lower in patients with normal nutritional status without obesity vs. those with obesity (mean difference: -0.7126, p <0.05), while in patients with mild malnutrition, HOMA-IR values were higher, but no differences were noted between the groups with or without obesity. Conclusion: In patients with T2D, malnutrition associated with lower triglycerides concentrations, even in the presence of obesity. Malnutrition and/or obesity associated with higher HOMA-IR, serum leptin levels and lower C peptide/leptin ratio.

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“…Rather, the ESRD risk of individuals with no obesity and no abdominal obesity tended to be higher than that of individuals with obesity but no abdominal obesity. However, the statistical significance was lost when the model was additionally adjusted for baseline eGFR, which may be associated with chronic malnutrition and elevated protein catabolism from advanced CKD . Obesity has been linked to an increased risk for ESRD incidence, as well as the development and progression of CKD, in epidemiologic studies with general or nondiabetes populations .…”

Section: Discussionmentioning

confidence: 99%

Risk of end‐stage renal disease from chronic kidney disease defined by decreased glomerular filtration rate in type 1 diabetes: A comparison with type 2 diabetes and the effect of metabolic syndrome

Lee

Han

Kim

et al. 2019

Diabetes Metabolism Res

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Background:We estimated the end-stage renal disease (ESRD) risk of chronic kidney disease (CKD) in patients with type 1 diabetes (T1D). The ESRD risk of CKD in patients with T1D was compared with that of CKD in patients without diabetes and with type 2 diabetes (T2D). We also evaluated the predictive value of metabolic syndrome (MetS) for ESRD development in CKD patients with T1D. Materials and Methods: The Korean National Health Insurance Service datasets of preventive health check-ups from 2009 to 2016 were used. The risk of incident ESRD was analysed according to the presence and type of diabetes in CKD (defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m 2 ) patients aged 20 years or older. Incident ESRD risk according to the presence of MetS was calculated among adult patients with CKD and T1D. Results: During 10 701 375.84 person-years of follow-up, 43 693 cases of ESRD developed. Hazard ratios (HRs) for incident ESRD from CKD in the T1D group were 2.580 (95% confidence interval [CI], 2.336-2.849) and 9.267 (95% CI, 8.378-10.251) compared with T2D and nondiabetes groups, respectively. In CKD patients with T1D, the presence of MetS increased incident ESRD risk by an HR of 2.023 (95% CI, 1.501-2.727). Conclusions:The presence of diabetes increases the risk for ESRD development from CKD. Furthermore, patients with T1D have a higher risk for ESRD incidence from CKD than do patients with T2D in a Korean population. MetS may be a useful predictor for ESRD in CKD patients with T1D.

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Protein Nutrition and Malnutrition in CKD and ESRD

Cited by 213 publications

References 170 publications

A Low-Cost, Intradialytic, Protein-Rich Meal Improves the Nutritional Status in Chinese Hemodialysis Patients

A Low-Cost, Intradialytic, Protein-Rich Meal Improves the Nutritional Status in Chinese Hemodialysis Patients

Malnutrition and Metabolic Changes in Patients with Type 2 Diabetes

Risk of end‐stage renal disease from chronic kidney disease defined by decreased glomerular filtration rate in type 1 diabetes: A comparison with type 2 diabetes and the effect of metabolic syndrome

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