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A Nephro-Nutrition Approach in Patients with Chronic Kidney Disease and Dialysis

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (15 July 2024) | Viewed by 15845

Special Issue Editors

Prof. Dr. Guillermina Barril

E-Mail Website
Guest Editor
Fundación Investigaciones Biomédicas, Instituto de Investigación Hospital Universitario de la Princesa, Madrid, Spain
Interests: nutritional status; inflammation body composition; chronic kidney disease; parenteral nutrition
Special Issues, Collections and Topics in MDPI journals
Dr. Mar Ruperto Lopez

E-Mail Website
Co-Guest Editor
Department of Pharmaceutical & Health Sciences, Faculty of Pharmacy, Universidad San Pablo-CEU, Madrid, Spain
Interests: disease-related malnutrition; obesity; sarcopenia; frailty; body composition; diet therapy; oral nutritional supplements; enteral nutrition; parenteral nutrition

Special Issue Information

Dear Colleagues,

The incidence of protein-energy wasting (PEW) increases as chronic kidney disease (CKD) progresses. However, PEW is more frequently detected in dialysis, and with a different profile depending on the dialysis technique used in the CKD patient, including either hemodialysis (HD) or peritoneal dialysis (PD).

In HD patients, protein loss will not generally be a problem, although the different HD techniques involve high energy consumption, which must be carefully monitored.  Thus, it is common in clinical practice to observe that the different HD schedules (incremental, online hemodiafiltration, HFR, daily HD, or high cut-off HD) modify patients' protein and energy requirements depending on the HD schedule.

When the renal patient is on PD, glucose absorption through the peritoneum makes it difficult for energy intake to be deficient. However, protein loss through the peritoneum, especially in episodes of peritonitis, makes it a priority to maintain sufficient protein intake.

From the initial stages of CKD, mainly in advanced chronic kidney disease, it is necessary to assess nutritional status so that renal patients start renal replacement therapy in the best possible nutritional status, as this is a predictor of morbidity and mortality in the first two years of dialysis.

The prevention of PEW, from the different stages of CKD, the correction of inflammation, and the adequacy of the different dialysis schedules together with nutritional intervention with oral nutritional supplements or intradialytic parenteral nutrition in HD and the use of protein modules require a comprehensive nephrology-nutrition approach within the holistic care of dialysis patients.

Prof. Dr. Guillermina Barril
Dr. Mar Ruperto Lopez
Guest Editors

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Keywords

  • Chronic Kidney Disease
  • CKD
  • protein-energy wasting
  • protein intake
  • nutritional supplements
  • nutrition
  • parenteral nutrition
  • Nephro-Nutrition

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Published Papers (5 papers)

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17 pages, 2074 KiB  
Article
Oral Frailty as a Risk Factor for Malnutrition and Sarcopenia in Patients on Hemodialysis: A Prospective Cohort Study
by Kota Miyasato, Yu Kobayashi, Kiyomi Ichijo, Ryo Yamaguchi, Hiroyuki Takashima, Takashi Maruyama and Masanori Abe
Nutrients 2024, 16(20), 3467; https://doi.org/10.3390/nu16203467 - 13 Oct 2024
Cited by 1 | Viewed by 3388
Abstract
Background: Oral frailty is a concept that encompasses various aspects of impaired oral function in elderly people, leading to reduced food intake and less dietary diversity, which can result in sarcopenia and physical frailty. However, there have been no studies on the relationship [...] Read more.
Background: Oral frailty is a concept that encompasses various aspects of impaired oral function in elderly people, leading to reduced food intake and less dietary diversity, which can result in sarcopenia and physical frailty. However, there have been no studies on the relationship between oral frailty and malnutrition, sarcopenia, and physical frailty in patients on hemodialysis (HD). Methods: This prospective observational cohort study assessed the oral status of patients on HD. The patients were divided into an oral frailty group and non-oral frailty group using the Oral Frailty Index-8. Malnutrition was assessed using the Geriatric Nutritional Risk Index (GNRI), the Nutritional Risk Index for Japanese Hemodialysis Patients (NRI-JH), and the Short-Form Mini-Nutritional Assessment (MNA-SF). Sarcopenia was assessed using the Asian Working Group for Sarcopenia 2019’s criteria. Physical frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria. One year later, the changes in nutritional status, sarcopenia, and physical frailty risk categories were compared between the oral frailty and non-oral frailty groups. Results: The study enrolled 201 patients (non-oral frailty group, 123; oral frailty group, 78). After 1 year, the oral frailty group had a significantly higher proportion of patients with worsening nutrition status (GNRI, p = 0.0011; NRI-JH, p = 0.0019; MNA-SF, p < 0.001) and sarcopenia (p = 0.0024). There was no significant between-group difference in the proportion of patients in a worse risk category for physical frailty after 1 year. Conclusions: Oral frailty predicts future malnutrition and the progression of sarcopenia in HD patients. In particular, our results strongly suggested that oral frailty was a strong determinant of worsening malnutrition and sarcopenia in HD patients aged ≥65 years. Full article
(This article belongs to the Special Issue A Nephro-Nutrition Approach in Patients with Chronic Kidney Disease and Dialysis)
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17 pages, 2350 KiB  
Article
Clinical Significance of Nutritional Status, Inflammation, and Body Composition in Elderly Hemodialysis Patients—A Case–Control Study
by Mar Ruperto and Guillermina Barril
Nutrients 2023, 15(24), 5036; https://doi.org/10.3390/nu15245036 - 8 Dec 2023
Cited by 2 | Viewed by 2605
Abstract
Nutritional and inflammatory disorders are factors that increase the risk of adverse clinical outcomes and mortality in elderly hemodialysis (HD) patients. This study aimed to examine nutritional and inflammation status as well as body composition in older adults on HD compared to matched [...] Read more.
Nutritional and inflammatory disorders are factors that increase the risk of adverse clinical outcomes and mortality in elderly hemodialysis (HD) patients. This study aimed to examine nutritional and inflammation status as well as body composition in older adults on HD compared to matched controls. A case–control study was conducted on 168 older participants (84 HD patients (cases) and 84 controls) age- and sex-matched. Demographic, clinical, anthropometric, and laboratory parameters were collected from medical records. The primary outcome was nutritional status assessment using a combination of nutritional and inflammatory markers along with the geriatric nutritional risk index (GNRI). Sarcopenic obesity (SO) was studied by the combined application of anthropometric measures. Body composition and hydration status were assessed by bioelectrical impedance analysis (BIA). Univariate and multivariate regression analyses were performed to identify nutritional and inflammatory independent risk indicators in elderly HD patients and controls. A significantly high prevalence of nutritional risk measured by the GNRI was found in HD patients (32.1%) compared to controls (6.0%) (p < 0.001). Elderly HD patients were overweight and had lower percent arm muscle circumference, phase angle (PA), serum albumin (s-albumin), as well as higher percent extracellular body water (ECW%) and serum C-reactive protein (s-CRP) than controls (all at least, p < 0.01). SO was higher in HD patients (15.50%) than in controls (14.30%). By multi-regression analyses, age < 75 years (OR: 0.119; 95%CI: 0.036 to 0.388), ECW% (OR: 1.162; 95%CI: 1.061 to 1.273), PA (OR: 0.099; 95%CI: 0.036 to 0.271), as well as BMI, s-albumin ≥ 3.8 g/dL, and lower s-CRP were independently related between cases and controls (all at least, p < 0.05). Elderly HD patients had increased nutritional risk, SO, inflammation, overhydration, and metabolic derangements compared to controls. This study highlights the importance of identifying nutritional risk along with inflammation profile and associated body composition disorders in the nutritional care of elderly HD patients. Further studies are needed to prevent nutritional disorders in elderly HD patients. Full article
(This article belongs to the Special Issue A Nephro-Nutrition Approach in Patients with Chronic Kidney Disease and Dialysis)
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11 pages, 1247 KiB  
Article
Elevated Ferritin Levels Associated with High Body Fat Mass Affect Mortality in Peritoneal Dialysis Patients
by Hyung Seok Lee, Hye-Mi Noh, Jung Nam An, Young Rim Song, Sung Gyun Kim and Jwa-Kyung Kim
Nutrients 2023, 15(9), 2149; https://doi.org/10.3390/nu15092149 - 29 Apr 2023
Cited by 4 | Viewed by 2816
Abstract
Obesity is a common health problem in peritoneal dialysis (PD) patients and causes high serum ferritin levels. However, mixed results have been reported on whether serum ferritin levels affect the prognosis of PD patients. We investigated the effect of increased adiposity on ferritin [...] Read more.
Obesity is a common health problem in peritoneal dialysis (PD) patients and causes high serum ferritin levels. However, mixed results have been reported on whether serum ferritin levels affect the prognosis of PD patients. We investigated the effect of increased adiposity on ferritin levels and its association with mortality in 350 well-nourished PD patients. Body composition was measured using a portable whole-body bioimpedance spectroscope, and clinical determinants of high ferritin levels were evaluated. High ferritin levels (≥600 ng/mL) were observed in 63 (18.0%) patients. Patients with high ferritin levels had a significantly higher body fat percentage and a lower lean tissue index than patients with low or normal ferritin levels. During a median follow-up of 30 months, there were 65 deaths. Ferritin ≥ 600 ng/mL was associated with significantly higher all-cause mortality compared with 200–600 ng/mL of ferritin. Multivariate analysis showed that high ferritin levels were significantly associated with a higher percentage of body fat after adjustment for lean tissue index and volume status. High ferritin increased all-cause mortality in PD patients, and increased fat mass was an important determinant of the high ferritin. Our results support that adiposity may lead to an adverse clinical outcome in PD patients. Full article
(This article belongs to the Special Issue A Nephro-Nutrition Approach in Patients with Chronic Kidney Disease and Dialysis)
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12 pages, 2383 KiB  
Article
Low-Dose Oral Iron Replacement Therapy Is Effective for Many Japanese Hemodialysis Patients: A Retrospective Observational Study
by Chie Ogawa, Ken Tsuchiya, Mineko Kanemitsu and Kunimi Maeda
Nutrients 2023, 15(1), 125; https://doi.org/10.3390/nu15010125 - 27 Dec 2022
Cited by 4 | Viewed by 3224
Abstract
Western guidelines recommend the use of intravenous iron supplementation for hemodialysis patients. However, in Japanese patients with well-controlled inflammation, iron replacement may be achieved with oral iron supplementation. This study involved 108 courses in 77 outpatient hemodialysis patients who received low-dose oral iron [...] Read more.
Western guidelines recommend the use of intravenous iron supplementation for hemodialysis patients. However, in Japanese patients with well-controlled inflammation, iron replacement may be achieved with oral iron supplementation. This study involved 108 courses in 77 outpatient hemodialysis patients who received low-dose oral iron replacement therapy. Data from baseline to week 28 of treatment were analyzed to identify factors associated with effectiveness. Changes over time in erythrocyte- and iron-related parameters and erythropoiesis-stimulating agent (ESA) dose were investigated in the effective group. A total of 84 courses (77.8%) satisfied the effectiveness criteria. Compared with the effective and ineffective groups, only C-reactive protein (CRP) was significantly different (p < 0.01). ROC curve analysis with efficacy as the endpoint showed a CRP cut point value of ≤0.1 mg/dL (area under the curve, 0.69; 95% confidence interval, 0.57–0.81). The relationship between serum ferritin and hemoglobin fluctuation by reducing the ESA dose showed a positive correlation (p < 0.001). In the ESA maintenance group, the serum ferritin gradually increased and then remained constant at about 60 ng/mL. Our data suggest that patients with CRP ≤ 0.1 mg/dL may benefit from low doses of oral iron supplementation. Approximately 60 ng/mL serum ferritin may be sufficient during stable hematopoiesis. Full article
(This article belongs to the Special Issue A Nephro-Nutrition Approach in Patients with Chronic Kidney Disease and Dialysis)
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28 pages, 1030 KiB  
Systematic Review
Potential Effects of Bioactive Compounds of Plant-Based Foods and Medicinal Plants in Chronic Kidney Disease and Dialysis: A Systematic Review
by Esmeralda Josa, Guillermina Barril and Mar Ruperto
Nutrients 2024, 16(24), 4321; https://doi.org/10.3390/nu16244321 - 14 Dec 2024
Viewed by 2501
Abstract
Background. The bioactive components of plant foods and medicinal plants have attracted interest due to their potential impact on the progression of chronic kidney disease (CKD) and outcomes. Objective. This study aimed to conduct a critical and quantitative systematic review of randomized clinical [...] Read more.
Background. The bioactive components of plant foods and medicinal plants have attracted interest due to their potential impact on the progression of chronic kidney disease (CKD) and outcomes. Objective. This study aimed to conduct a critical and quantitative systematic review of randomized clinical trials (RCTs) investigating the potential effects of selected phytochemicals from plant-based foods and medicinal plants in CKD and dialysis patients. Methods. The review included studies that related plant-based bioactive compounds (curcumin, propolis, sulforaphane, betalain, catechins, rhein, emodin, aloe-emodin, flavonoids, and triptolide) and medicinal plants (green tea, rhubarb, Astragalus membranaceus, and Tripterygium wilfordii Hook F) in CKD and dialysis patients. A literature search was conducted in PubMed, LILACS, Embase, Scopus, and WOS between December 2022 and October 2024. This review was performed according to the PRISMA flowchart and was registered in PROSPERO (595162). Results. In the eight RCTs conducted with curcumin, anti-inflammatory, antioxidant, and microbiota-modulating properties were reported. As for propolis, in three RCTs, anti-inflammatory, anti-proteinuric, and renal-protective properties were reported. Sulforaphane in one RCT showed antioxidant and cardiovascular benefits, and in another RCT no effects were observed. In one RCT, genistein was shown to be a potential anti-inflammatory agent and improved nutritional status. Allicin in two RCTs showed cardioprotective, antioxidant, anti-inflammatory, and lipid-lowering effects. Finally, beetroot showed a vasodilator effect in one RCT. As for the medicinal plants, green tea, rhubarb, Astragalus membranaceus, and Tripterygium Wilfordii Hook F, in six RCTs they showed antioxidant, anti-inflammatory, cardioprotective, antiproteinuric, and renoprotective properties. Conclusions. These results suggest that bioactive compounds of plant-based foods and medicinal plants have promising effects in terms of preventing or treating CKD progression and appear to improve inflammation and antioxidant capacity and support cardiovascular benefits and renoprotective effects; however, it is recommended that further studies be carried out. Full article
(This article belongs to the Special Issue A Nephro-Nutrition Approach in Patients with Chronic Kidney Disease and Dialysis)
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