- Differences between Measured Total Nitrogen Losses in Spent Peritoneal Dialysate Effluent and Estimated Nitrogen Losses. [Journal Article]
- JRJ Ren Nutr 2019; 29(3):243-247
- CONCLUSIONS: Our findings demonstrate that at higher protein losses, the currently used predictive equations underestimate the amount lost. It is important to attempt to compensate the iatrogenic protein loss by recommending the appropriate intake of dietary protein to patients, in an attempt to minimize muscle wasting. This discrepancy may have arisen because of the characteristics of newer PD prescriptions and change in patient demographics. We propose a new equation PNA g/day = 0.31 × (urea loss mmol) + 7.17, which will require prospective validation in additional studies.
- Estimating Dietary Protein Intake in Peritoneal Dialysis Patients: The Effect of Ethnicity. [Journal Article]
- PDPerit Dial Int 2018 Sep-Oct; 38(5):384-387
- Kidney dialysis patients with sarcopenia have increased mortality. Clinical guidelines recommend peritoneal dialysis (PD) patients have a target daily protein intake to prevent sarcopenia. Protein in…
Kidney dialysis patients with sarcopenia have increased mortality. Clinical guidelines recommend peritoneal dialysis (PD) patients have a target daily protein intake to prevent sarcopenia. Protein intake is estimated from total daily urea losses in urine and peritoneal dialysate to assess the protein equivalent of nitrogen appearance rate adjusted for body weight (nPNA). Dietary habits differ among ethnic groups, so we reviewed nPNA and body composition in a multi-ethnic PD population. Body composition was measured with multifrequency bioimpedance in 598 patients (301 white, 136 black, 123 South-Asian, and 38 Asian-Pacific). South-Asians had a lower nPNA compared with white and black individuals (Randerson 0.80 ± 0.21 vs 0.88 ± 0.24 and 0.85 ± 0.24 g/kg/day, Blumenkrantz 0.97 ± 0.14 vs 1.04 ± 0.22 and 0.99 ± 0.22 g/kg/day, Bergström 0.87 ± 0.4 vs 0.95 ± 0.24 and 0.92 ± 0.24 g/kg/day all p < 0.001). South-Asians had lower weights (68.9 ± 14.9 vs 74.4 ± 16.6 and 73.5 ± 16.3 kg, p < 0.001), and although of similar body mass index (25.9 ± 4.9 vs 28.5 ± 4.9 and 26.5 ± 5.2 kg/m2), had both lower skeletal muscle and appendicular muscle mass indexed for height (9.08 ± 1.45 vs 9.89 ± 1.62 and 10.1 ± 1.85, p < 0.001; and 6.95 ± 1.39 vs 7.68 ± 1.48 and 7.67 ± 1.58 kg/m2p < 0.01). South-Asian patients had a lower calculated basal metabolic rate (BMR) (1,358 ± 218 vs 1,487 ± 257 and 1,489 ± 271 kcal/day, p < 0.001).Asian PD patients, particularly South-Asians, have lower dietary protein intakes when calculated by nPNA. However, South-Asians had lower measured muscle mass and calculated BMR. As such, dietary protein intake targets derived from studies in 1 ethnic group are not necessarily applicable for all patients, as those with less muscle mass and lower BMR may well need less daily protein intake to maintain homeostasis.
- Does Low-Protein Diet Influence the Uremic Toxin Serum Levels From the Gut Microbiota in Nondialysis Chronic Kidney Disease Patients? [Journal Article]
- JRJ Ren Nutr 2018; 28(3):208-214
- CONCLUSIONS: LPD seems be a good strategy to reduce the uremic toxins production by the gut microbiota in nondialysis CKD patients.
- Does Whey Protein Supplementation Improve the Nutritional Status in Hypoalbuminemic Peritoneal Dialysis Patients? [Controlled Clinical Trial]
- TATher Apher Dial 2017; 21(5):485-492
- Limited data are available regarding the effects of whey protein on the nutritional status of the peritoneal dialysis population. This study evaluated the effects of whey protein supplementation for …
Limited data are available regarding the effects of whey protein on the nutritional status of the peritoneal dialysis population. This study evaluated the effects of whey protein supplementation for 12 weeks on the nutritional status in hypoalbuminemic peritoneal dialysis patients. Thirty-six stable adult patients on maintenance peritoneal dialysis with serum albumin levels <3.5 g/dL were enrolled in the study and were divided into two groups similar in their serum albumin and normalized protein equivalent of total nitrogen appearance (nPNA). Nineteen patients were instructed to receive 1.2 g/kg per day of protein diet and additional whey protein supplement at a dose of 25% of the instructed daily protein diet (whey protein group), and 17 patients were instructed to receive 1.2 g/kg per day protein diet without additional whey protein supplementation (control group). Nutritional status was assessed using two measures: nPNA and lean tissue mass index (LTI) obtained by whole-body bioimpedance spectroscopy technique. In the whey protein group serum albumin and nPNA significantly increased from baseline to week 6 (P < 0.001, P = 0.034; respectively) and from week 6 to week 12 (P < 0.001, P = 0.001; respectively); LTI significantly increased from week 6 to week 12 (P = 0.022). Compared to the control group at week 12, serum albumin, nPNA and LTI values were significantly higher in the whey protein group (P < 0.001, P = 0.002, P = 0.001; respectively). This study demonstrated for the first time that oral supplementation with whey protein improves nutritional status and is well tolerated in hypoalbuminemic PD patients.
- Whey protein and albumin effects upon urinary risk factors for stone formation. [Journal Article]
- UUrolithiasis 2017; 45(5):421-428
- Protein supplements are consumed for an expected increase in muscle mass and improved exercise performance, but as their impact on lithogenic parameters are unknown, we aimed to evaluate the effects …
Protein supplements are consumed for an expected increase in muscle mass and improved exercise performance, but as their impact on lithogenic parameters are unknown, we aimed to evaluate the effects of Whey protein (WP) and Albumin upon the risk factors for nephrolithiasis. WP or Albumin supplements (one scoop/day) were administered for 3 days to 18 healthy volunteers, with 1-week washout period between them. Serum and 24-h urine samples were collected at baseline and after completing each intervention. All participants were asked to replicate their baseline diet during the subsequent urine collection. After WP or albumin, mean protein equivalent of nitrogen appearance (PNA) was significantly higher (p < 0.001), as the result of the consumption of each of the supplements, but mean urinary calcium, phosphorus, sodium, potassium, uric acid, citrate, oxalate, magnesium, creatinine, pH, and urinary saturation indices did not differ from baseline. However, individual increases higher than 50% in urinary calcium were observed in 39% of the individuals and variable decreases in urinary pH in 44 and 67% of them, respectively, after WP or Albumin. Increases higher than 50% in urinary sodium occurred in one-third of them after Albumin. A short-term consumption of WP or albumin by healthy subjects, under controlled diet, did not significantly change the mean lithogenic parameters. Nevertheless, the wide individual variation and relevant increases/decreases observed for urinary calcium, sodium, and pH suggest the need of a closer surveillance of these parameters and adequacy of diet in case of supplementation by stone formers.
- Lower serum fibroblast growth factor-23 levels may suggest malnutrition in maintenance haemodialysis patients. [Journal Article]
- NNephrology (Carlton) 2014; 19(9):568-73
- CONCLUSIONS: The determinants of the serum FGF-23 level in MHD patients without residual renal function were age, serum phosphate, Ca, iPTH levels, the active vitamin D dose and the GNRI. The lower serum FGF-23 levels may suggest malnutrition in MHD patients.
- Target weight gain during the first year of hemodialysis therapy is associated with patient survival. [Journal Article]
- NCNephron Clin Pract 2014; 126(3):128-34
- CONCLUSIONS: The initial fluid removal was related to nutritional markers. The secondary TGW change during the first year of HD treatment calculated after the initial phase of fluid removal was identified as a strong predictor of survival. It was associated with a better food intake whereas the patient case mix was not different. These data highlight the importance of nutrition and food intake in the first year of dialysis therapy and the need for nutritional follow-up and support in incident HD patients. It stresses the need in understanding the key factors associated with food intake in this setting.
- Protein-energy wasting, as well as overweight and obesity, is a long-term risk factor for mortality in chronic hemodialysis patients. [Journal Article]
- IUInt Urol Nephrol 2014; 46(3):615-21
- CONCLUSIONS: We showed that low values of SGA, nPNA, and PhA independently predict mortality in HD patients. In conjunction with an earlier study, we demonstrated that the relative risk of death associated with these markers is highest during the first year of monitoring and it decreases in the following 4 years, although it still remains significantly increased. On the other hand, overweight and obesity were also associated with lower survival after 5 years, whereas this association was not apparent after 1 year.
- Effects of low-glucose degradation product solution on peritoneal membrane characteristics in peritoneal dialysis patients: a 3-year follow-up study. [Journal Article]
- IJIran J Kidney Dis 2014; 8(1):58-64
- CONCLUSIONS: The present study shows that a low-GDP solution may be associated with preserving the mesothelial cell and peritoneal membrane characteristics.
New Search Next
- Does the adequacy parameter Kt/V(urea) reflect uremic toxin concentrations in hemodialysis patients? [Journal Article]
- PlosPLoS One 2013; 8(11):e76838
- Hemodialysis aims at removing uremic toxins thus decreasing their concentrations. The present study investigated whether Kt/V(urea), used as marker of dialysis adequacy, is correlated with these conc…
Hemodialysis aims at removing uremic toxins thus decreasing their concentrations. The present study investigated whether Kt/V(urea), used as marker of dialysis adequacy, is correlated with these concentrations. Predialysis blood samples were taken before a midweek session in 71 chronic HD patients. Samples were analyzed by colorimetry, HPLC, or ELISA for a broad range of uremic solutes. Solute concentrations were divided into four groups according to quartiles of Kt/V(urea), and also of different other parameters with potential impact, such as age, body weight (BW), Protein equivalent of Nitrogen Appearance (PNA), Residual Renal Function (RRF), and dialysis vintage. Dichotomic concentration comparisons were performed for gender and Diabetes Mellitus (DM). Analysis of Variance in quartiles of Kt/V(urea) did not show significant differences for any of the solute concentrations. For PNA, however, concentrations showed significant differences for urea (P<0.001), uric acid (UA), p-cresylsulfate (PCS), and free PCS (all P<0.01), and for creatinine (Crea) and hippuric acid (HA) (both P<0.05). For RRF, concentrations varied for β₂-microglobulin (P<0.001), HA, free HA, free indoxyl sulfate, and free indole acetic acid (all P<0.01), and for p-cresylglucuronide (PCG), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), free PCS, and free PCG (all P<0.05). Gender and body weight only showed differences for Crea and UA, while age, vintage, and diabetes mellitus only showed differences for one solute concentration (UA, UA, and free PCS, respectively). Multifactor analyses indicated a predominant association of concentration with protein intake and residual renal function. In conclusion, predialysis concentrations of uremic toxins seem to be dependent on protein equivalent of nitrogen appearance and residual renal function, and not on dialysis adequacy as assessed by Kt/V(urea). Efforts to control intestinal load of uremic toxin precursors by dietary or other interventions, and preserving RRF seem important approaches to decrease uremic solute concentration and by extension their toxicity.