Nutrition and chronic kidney disease

Department of Nephrology, Hôpital Edouard Herriot, Lyon, France.
Kidney International (Impact Factor: 8.52). 05/2011; 80(4):348-57. DOI: 10.1038/ki.2011.118
Source: PubMed

ABSTRACT The incidence of malnutrition disorders in chronic kidney disease (CKD) appears unchanged over time, whereas patient-care and dialysis techniques continue to progress. Despite some evidence for cost-effective treatments, there are numerous caveats to applying these research findings on a daily care basis. There is a sustained generation of data confirming metabolic improvement when patients control their protein intake, even at early stages of CKD. A recent protein-energy wasting nomenclature allows a simpler approach to the diagnosis and causes of malnutrition. During maintenance dialysis, optimal protein and energy intakes have been recently challenged, and there is no longer an indication to control hyperphosphatemia through diet restriction. Recent measurements of energy expenditure in dialysis patients confirm very low physical activity, which affects energy requirements. Finally, inflammation, a common state during CKD, acts on both nutrient intake and catabolism, but is not a contraindication to a nutritional intervention, as patients do respond and improve their survival as well as do noninflamed patients.

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    ABSTRACT: Background: Malnutrition, which is a powerful predictor of morbidity and mortality, is common in patients undergoing hemodialysis. Therefore, for a better overall outcome, adequate nutrition is very important for such patients. Objectives: The current study mainly aimed to investigate the relationship between nutritional markers, anthropometric parameters such as body mass index (BMI), and routine laboratory parameters with mortality in patients undergoing hemodialysis. Patients and Method: The demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, total protein, triglyceride, cholesterol, blood urea nitrogen (BUN), and creatinine of 260 patients treated from May 2001 to July 2011 were analyzed, retrospectively. The patients were followed-up regularly for one year. Lastly, the year follow-up was completed by 90 patients. Results: The results showed that statistically significant correlation between albumin serum levels (P = 0.001) and duration of hemodialysis (P = 0.001) with survival in patients undergoing hemodialysis. No statistically significant correlation was found between gender, BMI, triglyceride, cholesterol, BUN, and creatinine with survival in patients undergoing hemodialysis. Conclusions: The results of the current study suggested that low serum albumin levels and duration of hemodialysis were strong predictors of mortality and morbidity among patients undergoing hemodialysis.
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    ABSTRACT: Kidney function measured as estimated glomerular filtration rate (eGFR) is a risk factor for mortality and severe diseases. Protein intake up-regulates kidney function. The dose-response curve of eGFR over protein intake is unknown. Urinary urea nitrogen is an objective index of protein intake. The study cross-sectionally analysed the relation between overnight urinary urea nitrogen (onU-ureaN) and eGFR with and without control for other variables in 4106 adults of the Gubbio population. Analyses were done for serum creatinine (S-cr) also to investigate the independency of results from eGFR calculation. Higher onU-ureaN associated with higher eGFR, and lower S-cr independently of sex and age (simple and partial correlation coefficients >0.100, P < 0.001). Analyses by onU-ureaN decile indicated sigmoid curves of eGFR and S-cr over onU-ureaN with trend to flatness in the lowest 20% and the highest 20% of onU-ureaN (<5.19 and >10.12 mg/h, respectively). Multi-variable spline regression indicated that the relation of eGFR over onU-ureaN was non-significant for onU-ureaN <5.19 mg/h (coefficient = +0.27, 95% CI = -0.31/+0.84, P = 0.364), positive for onU-ureaN in the range 5.19-10.12 mg/h (coefficients = 1.35-1.64, lower 95% CI ≥ +0.48, P ≤ 0.002), and non-significant for onU-ureaN >10.12 mg/h (coefficient = +0.05, 95% CI = -0.06/ +0.16, P = 0.394). eGFR differed by ≈8 mL/min × 1.73 m(2) between the lowest and highest 20% of onU-ureaN distribution. Higher protein intake relates to higher eGFR. The relation is sigmoid with eGFR up-regulation for onU-ureaN >5.19 mg/h, a threshold approximately corresponding to the recommended daily allowance for protein intake (0.8 g/day per kg of ideal weight). © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
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