DOI QR코드

DOI QR Code

Assessment of Malnutrition of Dialysis Patients and Comparison of Nutritional Parameters of CAPD and Hemodialysis Patients

  • Wi, Jin Woo (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Nam-Ho (Department of Internal Medicine, Chonnam National University Medical School)
  • Received : 2017.08.27
  • Accepted : 2017.09.26
  • Published : 2017.09.30

Abstract

Malnutrition is common and the major risk factor of mortality of end stage renal disease (ESRD) patients. The aim of this study is to assess nutritional status of malnutrition patients on dialysis by various methods and compare nutritional parameters of continuous ambulatory peritoneal dialysis (CAPD) patients with hemodialysis patients. 137 patients on dialysis from April 2009 to July 2013 were enrolled. Nutritional parameters of 66 CAPD and 71 hemodialysis patients were investigated by anthropometry, biochemical study, diet analysis and questionnaires. Malnutrition patients were selected by body mass index (BMI), serum albumin and pre-albumin based on International Society of Renal Nutrition and Metabolism (ISRNM) diagnostic criteria for protein-energy wasting and compared with non-malnutrition patients. In comparison of CAPD and hemodialysis patients, most anthropometric values showed no significant difference except total body water (TBW). TBW was lower in CAPD patients (P=0.024). Although serum albumin was slightly higher in hemodialysis patients (P=0.047), pre-albumin were significantly higher in CAPD patients (P=0.000). Serum blood urea nitrogen (BUN) was higher in hemodialysis patients (P=0.000). In diet analysis, Total calorie (P=0.000) and total cholesterol (P=0.012) intakes were higher in CAPD patients. Mean subjective global assessment (SGA) grade was higher in CAPD patients (P=0.003). Several nutritional parameters of CAPD patients were better than hemodialysis patients implying more intensive therapeutic approach may be needed for hemodialysis patients. We have to understand multiple factors contributing malnutrition of ESRD patients and individualized therapeutic approach is needed.

Keywords

References

  1. Bargman JM. The rationale and ultimate limitations of urea kinetic modelling in the estimation of nutritional status. Peritoneal Dialysis International. 1996. 16: 347-351.
  2. Bargman JM, Thorpe KE, Churchill DN. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. Journal of the American Society of Nephrology. 2001. 12: 2158-2162.
  3. Bergstrom J. Nutrition and mortality in hemodialysis. Journal of the American Society of Nephrology. 1995. 6: 1329-1341.
  4. Bergstrom J. Why are dialysis patients malnourished? American Journal of Kidney Diseases. 1995. 26: 229-241. https://doi.org/10.1016/0272-6386(95)90178-7
  5. Bossola M, Muscaritoli M, Tazza L, Giungi S, Tortorelli A, Rossi Fanelli F, Luciani G. Malnutrition in hemodialysis patients: what therapy? American Journal of Kidney Diseases. 2005. 46: 371-386. https://doi.org/10.1053/j.ajkd.2005.05.031
  6. Cheng LT, Tang W, Wang T. Strong association between volume status and nutritional status in peritoneal dialysis patients. American Journal of Kidney Diseases. 2005. 45: 891-902. https://doi.org/10.1053/j.ajkd.2005.01.037
  7. Chung SH, Stenvinkel P, Lindholm B, Avesani CM. Identifying and managing malnutrition stemming from different causes. Peritoneal Dialysis International. 2007. 27: 239-244.
  8. Chung SH, Carrero JJ, Lindholm B. Causes of poor appetite in patients on peritoneal dialysis. Journal of Renal Nutrition. 2011. 21: 12-15. https://doi.org/10.1053/j.jrn.2010.10.010
  9. Davies SJ, Phillips L, Griffiths AM, Naish PF, Russell GI. Analysis of the effects of increasing delivered dialysis treatment to malnourished peritoneal dialysis patients. Kidney International. 2000. 57: 1743-1754. https://doi.org/10.1038/sj.ki.4495463
  10. De Mutsert R, Grootendorst DC, Axelsson J, Boeschoten EW, Krediet RT, Dekker FW. Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrology Dialysis Transplantation. 2008. 23: 2957-2964. https://doi.org/10.1093/ndt/gfn167
  11. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN. What is subjective global assessment of nutritional status? Journal of Parenteral and Enteral Nutrition. 1987. 11: 8-13. https://doi.org/10.1177/014860718701100108
  12. Dombros N, Dratwa M, Feriani M, Gokal R, Heimburger O, Krediet R, Plum J, Rodrigues A, Selgas R, Struijk D, Verger. European best practice guidelines for peritoneal dialysis. 8 Nutrition in peritoneal dialysis. Nephrology Dialysis Transplantation. 2005. 20: 28-33.
  13. Dong J, Li Y, Xu Y, Xu R. Daily protein intake and survival in patients on peritoneal dialysis. Nephrology Dialysis Transplantation. 2011. 26: 3715-3721. https://doi.org/10.1093/ndt/gfr142
  14. Dukkipati R, Kopple JD. Causes and prevention of protein-energy wasting in chronic kidney failure. Seminars in Nephrology. 2009. 29: 39-49. https://doi.org/10.1016/j.semnephrol.2008.10.006
  15. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Trevino-Becerra A, Wanner C. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney International. 2008. 73: 391-398. https://doi.org/10.1038/sj.ki.5002585
  16. Gokal R, Oreopoulos DG. Is long-term technique survival on continuous ambulatory peritoneal dialysis possible? Peritoneal Dialysis International. 1996. 16: 553-555.
  17. Han DS, Lee SW, Kang SW, Choi KH, Lee HY, Cho EY, Lee JH. Factors affecting low values of serum albumin in CAPD patients. Advances in Peritoneal Dialysis. 1996. 12: 288-292.
  18. Han SH, Lee SC, Ahn SV, Lee JE, Choi HY, Kim BS, Kang SW, Choi KH, Han DS, Lee HY. Improving outcome of CAPD: twenty-five years' experience in a single Korean center. Peritoneal Dialysis International. 2007. 27: 432-440.
  19. Honda H, Qureshi AR, Axelsson J, Heimburger O, Suliman ME, Barany P, Stenvinkel P, Lindholm B. Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality. The American Journal of Clinical Nutrition. 2007. 86: 633-638. https://doi.org/10.1093/ajcn/86.3.633
  20. Kalantar-Zadeh K, Kopple JD. Obesity paradox in patients on maintenance dialysis. Contributions to Nephrology. 2006. 151:57-69.
  21. Krishnamoorthy V, Sunder S, Mahapatra HS, Verma H, Sharma N, Jayaraman R, Sathi S, Khanna S, Mohamed A. Evaluation of protein-energy wasting and inflammation on patients undergoing continuous ambulatory peritoneal dialysis and its correlations. Nephro-Urology Monthly. 2015. 29: e33143.
  22. Kovesdy CP, Kalantar-Zadeh K. Why is protein-energy wasting associated with mortality in chronic kidney disease? Seminars in Nephrology. 2009. 29: 3-14. https://doi.org/10.1016/j.semnephrol.2008.10.002
  23. Kovesdy CP, George SM, Anderson JE, Kalantar-Zadeh K. Outcome predictability of biomarkers of protein-energy wasting and inflammation in moderate and advanced chronic kidney disease. The American Journal of Clinical Nutrition. 2009. 90: 407-414. https://doi.org/10.3945/ajcn.2008.27390
  24. Maiorca R, Cancarini GC, Zubani R, Camerini C, Manili L, Brunori G, Movilli E. CAPD viability: a long-term comparison with hemodialysis. Peritoneal Dialysis International. 1996. 16: 276-287.
  25. Martin-Del-Campo F, Gonzalez-Espinoza L, Rojas-Campos E, Ruiz N, Gonzalez J, Pazarin L, Cueto-Manzano AM. Conventional nutritional counselling maintains nutritional status of patients on continuous ambulatory peritoneal dialysis in spite of systemic inflammation and decrease of residual renal function. Nephrology. 2009. 14: 493-498. https://doi.org/10.1111/j.1440-1797.2008.01081.x
  26. Prasad N, Gupta A, Sinha A, Sharma RK, Kumar A, Kumar R. Changes in nutritional status on follow-up of an incident cohort of continuous ambulatory peritoneal dialysis patients. Journal of Renal Nutrition. 2008. 18: 195-201. https://doi.org/10.1053/j.jrn.2007.08.002
  27. Ramkumar N, Pappas LM, Beddhu S. Effect of body size and body composition on survival in peritoneal dialysis patients. Peritoneal Dialysis International. 2005. 25: 461-469.
  28. Snyder JJ, Foley RN, Gilbertson DT, Vonesh EF, Collins AJ. Body size and outcomes on peritoneal dialysis in the United States. Kidney International. 2003. 64: 1838-1844. https://doi.org/10.1046/j.1523-1755.2003.00287.x
  29. Spiegel DM, Breyer JA. Serum albumin: a predictor of long-term outcome in peritoneal dialysis patients. American Journal of Kidney Diseases. 1994. 23: 283-285. https://doi.org/10.1016/S0272-6386(12)80985-1
  30. Stack AG, Murthy BV, Molony DA. Survival differences between peritoneal dialysis and hemodialysis among "large" ESRD patients in the United States. Kidney International. 2004. 65:2398-2408. https://doi.org/10.1111/j.1523-1755.2004.00654.x
  31. Stenvinkel P, Heimburger O, Lindholm B, Kaysen GA, Bergstrom J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrology Dialysis Transplantation. 2000. 15: 953-960. https://doi.org/10.1093/ndt/15.7.953
  32. Sum SS, Marcus AF, Blair D, Olejnik LA, Cao J, Parrott JS, Peters EN, Hand RK, Byham-Gray LD. Comparison of Subjective Global Assessment and Protein Energy Wasting Score to Nutrition Evaluations Conducted by Registered Dietitian Nutritionists in Identifying Protein Energy Wasting Risk in Maintenance Hemodialysis Patients. Journal of Renal Nutrition. 2017. 27: 325-332. https://doi.org/10.1053/j.jrn.2017.04.006
  33. Wang AY, Sea MM, Ip R, Law MC, Chow KM, Lui SF, Li PK, Woo J. Independent effects of residual renal function and dialysis adequacy on actual dietary protein, calorie, and other nutrient intake in patients on continuous ambulatory peritoneal dialysis. Journal of the American Society of Nephrology. 2001. 12: 2450-2457.