Simple methods for nutritional assessment in hemodialyzed patients

Abstract

Uremic patients undergoing hemodialysis are often catabolic and malnourished. To treat malnutrition effectively, a preliminary nutritional assessment is needed. Available techniques should enable the clinician to readily detect the presence of malnutrition and to follow the response to nutritional therapy. In a group of chronic uremic patients undergoing maintenance hemodialysis, the authors evaluated the nutritional status with the following indices: 1) assessment of the somatic fat and protein compartments by means of anthropometric measurements (weight/height ratio, triceps and subscapular skinfold thickness, and arm muscle circumference); 2) assessment of the visceral protein compartment (serum total protein, albumin, transferrin, pseudocholinesterase, C3, and immunoglobulin content); 3) assessment of cell-mediated immunity by means of skin tests ("skin window," PPD and phytohemagglutinin) and blood lymphocyte content; and 4) assessment of the dietary intake of nutrients with dietary diaries. Anthropometric indices, serum protein content (except immunoglobulins), and the immune response was generally lower than in normal subjects, suggesting a mixed marasmus-like and kwashiorkor-like pattern of protein-calorie malnutrition. The protein intake was normal, whereas the energy intake tended to be low. Protein intake was significantly correlated with the predialysis serum urea nitrogen. Due to the difficulties in improving oral energy intake and the negative nitrogen balance reported during the days of dialysis therapy, patients were given intravenous supplements of essential or essential and nonessential amino acids for 2 months. The effects of this short-term supplementation were limited.

Recirculation: Review, Techniques for Measurement and Ability to Predict Hemoaccess Stenosis before and after Angioplasty

“…This was lower than the level associated with ste nosis and recommended for further investi gation by reference sources [2][3][4]. An interdialytic rise in serum BUN as seen in case 1 is often secondary to dietary noncompliance or loss of residual renal function and is an unreliable indication of recirculation [20,21], In both cases the stenosis was di lated with good radiographic and functional results, and with a reduction in measured recirculation to less than 10%.…”

Protein Catabolic Factors in Patients on Renal Replacement Therapy

“…How ever. positive results have also been reported, especially in one study where there was evi dence that the patients were inadequately nourished prior to the start of essential amino acid therapy [78].…”

“…77, 78], The clinical and biochemical results of such supplementation have been presented in a recent review [79], On the basis of measurement of visceral pro teins as well as plasm amino acids, some authors conclude that the effect of essential amino acid supplementation is questionable, at least in hemodialysis patients with a rela tively high protein intake [74. 76,78]. How ever.…”

Diagnosis of Protein Calorie Malnutrition in Diabetic Patients on Hemodialysis and Peritoneal Dialysis

“…Most of the studies have reported a significant prevalence of malnutrition in this population [1][2][3][4][5]. However, the diabetic patients had usually been excluded from these studies.…”