Successful treatment of hypoalbuminemic hemodialysis patients with a modified regimen of oral essential amino acids

Bronich, Lauren; Te, Tite; Shetye, Kedar; Stewart, Tara L.; Eustace, Joseph A.

doi:10.1016/s1051-2276(01)70037-4

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…Oral nutritional supplements or intradialytic parenteral nutrition (IDPN) have proved either ineffectual [62,63,65] or only partially effective [66,67] in repair of hypoalbuminemia of hemodialysis patients in some studies. Others have had positive effects on both albumin and prealbumin levels [68,69], although these studies were longitudinal using baseline data as the control, rather than a prospective randomized study with a control group. The mixed results of nutritional intervention in correcting hypoalbuminemia suggest that other factors may be more important, even dominant in causing reduced albumin concentration in most or a large fraction of dialysis patients, or at least other factors require resolution before marked improvement in nutritional status can be achieved.…”

Section: What Is the Effect Of Improved Nutrient Intake?mentioning

confidence: 99%

Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy?

Kaysen

2003

Kidney International

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Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy? Serum albumin, transferrin, and prealbumin levels decrease as glomerular filtration rate (GFR) declines, even prior to the start of dialysis. The levels of these serum proteins are also associated with creatinine levels and lean body mass. Lean body mass also decreases with advancing renal failure. While all of these measures are regarded as reflections of nutritional status, each are strongly associated with any of several indicators of inflammation: positive acute-phase proteins or the cytokines that regulate their synthesis rate, in both longitudinal and cross-sectional studies. Inflammation in turn is associated with comorbid conditions, cardiovascular disease, chronic infections, age, and vascular access type. Additionally, dialysis patients are subjected to oxidative stress and exposure of blood to foreign antigens in the dialysis process that also potentially contribute to inflammation. In otherwise healthy individuals reduced protein and calorie intake does not cause hypoalbuminemia since albumin fractional catabolic rate (FCR) and resting energy expenditure (REE) normally decrease in response. The simultaneous occurrence of decreased protein intake and inflammation prevent these homeostatic compensations to reduced nitrogen and energy intake from occurring, resulting in decreasing albumin, transferrin, and prealbumin levels and loss of muscle mass. Nutritional intake may also be challenged as a result of renal failure associated with anorexia, gastroparesis, and socioeconomic factors, which may all cause nutritional intake to be sufficiently marginal so that the combined effects of inflammation and decrease protein intake are expressed as decreased visceral and somatic protein stores.

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Section: What Is the Effect Of Improved Nutrient Intake?mentioning

confidence: 99%

Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy?

Kaysen

2003

Kidney International

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“…We have identified clinical trials with at least 10 participants in which the effects of enteral nutritional interventions were examined in malnourished patients on dialysis (Tables 1–4). 17,40,43,44,51–80 In most of these studies, enteral therapy was associated with improved nutritional status or other clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Earlier studies examined the effect of essential amino acid supplementation on the nutritional status of patients with CKD. 43,44,51,58–60,69,70 Supplemental fish oil and other sources of omega 3 fatty acid have been tested. In a randomized trial by Tietze et al , 62 fish protein (8 g daily) and fish-based ingredients were tested for up to 6 months with some success.…”

Section: Introductionmentioning

confidence: 99%

Diets and enteral supplements for improving outcomes in chronic kidney disease

et al. 2011

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Protein-energy wasting (PEW), which is manifested by low serum levels of albumin or prealbumin, sarcopenia and weight loss, is one of the strongest predictors of mortality in patients with chronic kidney disease (CKD). Although PEW might be engendered by non-nutritional conditions, such as inflammation or other comorbidities, the question of causality does not refute the effectiveness of dietary interventions and nutritional support in improving outcomes in patients with CKD. The literature indicates that PEW can be mitigated or corrected with an appropriate diet and enteral nutritional support that targets dietary protein intake. In-center meals or oral supplements provided during dialysis therapy are feasible and inexpensive interventions that might improve survival and quality of life in patients with CKD. Dietary requirements and enteral nutritional support must also be considered in patients with CKD and diabetes mellitus, in patients undergoing peritoneal dialysis, renal transplant recipients, and in children with CKD. Adjunctive pharmacological therapies, such as appetite stimulants, anabolic hormones, and antioxidative or anti-inflammatory agents, might augment dietary interventions. Intraperitoneal or intradialytic parenteral nutrition should be considered for patients with PEW whenever enteral interventions are not possible or are ineffective. Controlled trials are needed to better assess the effectiveness of in-center meals and oral supplements.

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“…Different physiologic mechanisms and suggestions to alleviate this condition were suggested by such studies. [15][16][17][18][19][20][21][22][23][24][25] In addition, an association of serum albumin level with hemoglobin level in healthy control group. This finding could be due to confounding results related to inadequately small sample size of the study group.…”

Section: A B C D Ementioning

confidence: 96%

Inflammatory status as a contributor for anemia in patients with chronic kidney disease in Karbala, Iraq

Al-Khayat

Al-Ameri

Abode

2016

jcms

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Objective In chronic kidney disease (CKD), there is primary deficiency of erythropoietin, thereby leading to anemia. In addition, chronic immune activation and the inflammatory process could be involved in the pathophysiology of anemia in patients with (CKD). However, anemia and inflammation are present in earlier stages of renal impairment. The objective of this study was to evaluate the possible association of some of the markers of inflammation with anemia in patients with CKD with and without dialysis treatment. Methods The markers of inflammation such as white blood cell (WBC) count, granulocytes % and C-reactive protein (CRP) were determined. Similarly, serum albumin, platelets count and hemoglobin level were measured in blood samples from 61 patients with CKD attending Nephrology Unit at Al-Hussein Medical City and 20 healthy controls. The selected patients were stratified into two subgroups; 31 patients without hemodialysis (HD) and other 30 patients on HD. Results A significantly lower hemoglobin level, serum albumin and platelets count were observed in patients with CKD on hemodialysis therapy compared to controls, (P value = 0.0001). There was a significant correlation between WBC count and granulocytes % with regard to the low hemoglobin level in patients with CKD especially those on hemodialysis HD, (P value < 0.05). Conclusion Renal failure anemia was found to be strongly associated with high WBC count and gronulocytes percentage which are known markers of inflammatory status.

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Successful treatment of hypoalbuminemic hemodialysis patients with a modified regimen of oral essential amino acids

Cited by 6 publications

References 13 publications

Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy?

Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy?

Diets and enteral supplements for improving outcomes in chronic kidney disease

Inflammatory status as a contributor for anemia in patients with chronic kidney disease in Karbala, Iraq

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