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Nutritional and Hydration Status in Chronic Kidney Disease and Dialysis Patients

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

Deadline for manuscript submissions: closed (30 July 2023) | Viewed by 11879

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Special Issue Editor

Dr. Piergiorgio Bolasco

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Guest Editor

1. Chronic Kidney Insufficiency Research Group, Italian Society of Nephrology, Rome, Italy
2. Kidney Stones Pathologies Research Group, Italian Society of Nephrology, Rome, Italy
Interests: renal disease; dialysis; hemodialysis; chronic renal failure; renal; chronic kidney failure; clinical nephrology; kidney; randomized control trials; renal failure; prevention and diagnosis of kidney stones pathologies; renal nutrition
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Special Issue Information

Dear Colleagues,

I would like to draw to your attention an old, albeit relevant, topic: the nutrition and hydration status of chronic kidney disease (CKD) and dialysis patients. There are many correlations that link derangement of metabolic hydration status resulting by Chronic Uremic Diseases and Dialysis on the various body organs. Nowadays, it is especially essential and would be very useful to reconduct a state-of-the-art study on CKD and dialysis patients, especially in elderly patients. Therefore, innovative papers are welcomed that cover the following topics: methods for establishing the extent of hydration for various organs of the body, nutritional correlations that induce variation in body water content and vice versa, procedural strategies to optimize nutrition and hydration, metanalyses, the results of intervention procedures to optimize the nutritional and hydration status, and the impact of new diffusive and/or convective haemodialysis and peritoneal methodologies. These issues are particularly difficult to study making it even more challenging to identify the diagnostic and therapeutic strategies.

Dr. Piergiorgio Bolasco
Guest Editor

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Keywords

haemodialys hydration status
metabolic nutritional change in hemodialysis
nutritional evaluation of patients undergoing hemodialysis
intervention of nutritional and hydration in hemodialysis.

Published Papers (5 papers)

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Research

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14 pages, 2666 KiB

Open AccessArticle

Assessment of Hydration, Nutritional Status and Arterial Stiffness in Hypertensive Chronic Kidney Disease Patients

by Josipa Radić, Ela Kolak, Marijana Vučković, Andrea Gelemanović, Hana Đogaš, Dora Bučan Nenadić and Mislav Radić

Nutrients 2023, 15(9), 2045; https://doi.org/10.3390/nu15092045 - 24 Apr 2023

Viewed by 1692

Abstract

The aim of this cross-sectional study was to determine the body fluid volume in patients diagnosed with both chronic kidney disease (CKD) and arterial hypertension (AH), and to investigate the relationship between fluid overload (FO), nutritional status and arterial stiffness in this specific patient population. A total of 169 participants with CKD and AH were enrolled in the study, and data on general parameters, comorbidities, medication use, and laboratory parameters were collected. Body composition was assessed with a Tanita MC 780 device, and data on the central and peripheral systolic and diastolic blood pressure, as well as pulse wave velocity (PWV) and the augmentation index (AIx) were collected with an IEM Mobil-O-Graph 24 h ambulatory blood pressure monitor, which was based on oscillometry. The Mediterranean Diet Serving Score (MDSS) questionnaire was used to determine the adherence to the Mediterranean diet (MeDi). Our results showed that the significant positive predictors of hydration status were the use of diuretics and oral hypoglycemic agents, whereas the negative predictors were female sex, higher body mass index level and use of two or more antihypertensives in the form of a single-pill combination. We also found differences in blood pressure and arterial stiffness parameters in relation to volume status, along with differences based on the presence of diabetes mellitus (DM). In conclusion, these results call for a higher awareness of volume status in the care of CKD patients with AH, especially in those with diabetes mellitus. Full article

(This article belongs to the Special Issue Nutritional and Hydration Status in Chronic Kidney Disease and Dialysis Patients)

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17 pages, 1148 KiB

Open AccessArticle

Nutritional and Hydration Status and Adherence to Dietary Recommendations in Dalmatian Dialysis Patients

by Ela Kolak, Josipa Radić, Marijana Vučković, Dora Bučan Nenadić, Mirna Begović and Mislav Radić

Nutrients 2022, 14(17), 3553; https://doi.org/10.3390/nu14173553 - 29 Aug 2022

Cited by 3 | Viewed by 2104

Abstract

Protein-energy wasting (PEW) is considered one of the major complications of chronic kidney disease (CKD), particularly in dialysis patients. Insufficient energy and protein intake, together with clinical complications, may contribute to the onset and severity of PEW. Therefore, the aim of the study was to analyze the differences in nutritional and hydration status and dietary intake among Dalmatian dialysis patients. Fifty-five hemodialysis (HD) and twenty peritoneal dialysis (PD) participants were included. For each study participant, data about body composition, anthropometric, laboratory, and clinical parameters were obtained. The Malnutrition Inflammation Score (MIS) and two separate 24-h dietary recalls were used to assess nutritional status and dietary intake. The Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) were calculated to compare actual dietary intake with recommended intake. Additionally, the estimated 10-year survival was calculated using the Charlson Comorbidity Index. The prevalence of malnutrition according to MIS was 47.3% in HD and 45% in PD participants. Significant differences in fat tissue parameters were found between HD and PD participants, whereas significant differences in hydration status and muscle mass parameters were not found. A significant difference in NAR between HD and PD participants was noticed for potassium and phosphorus intake, but not for MAR. MIS correlated negatively with anthropometric parameters, fat mass, visceral fat level and trunk fat mass, and iron and uric acid in HD participants, whereas no significant correlations were found in PD participants. The estimated 10-year survival correlated with several parameters of nutritional status in HD and PD participants, as well as nutrient intake in HD participants. These results indicate a high prevalence of malnutrition and inadequate dietary intake in the Dalmatian dialysis population which, furthermore, highlights the urgent need for individualized and structural nutritional support. Full article

(This article belongs to the Special Issue Nutritional and Hydration Status in Chronic Kidney Disease and Dialysis Patients)

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13 pages, 306 KiB

Open AccessArticle

Effects of a Novel Amino Acid Formula on Nutritional and Metabolic Status, Anemia and Myocardial Function in Thrice-Weekly Hemodialysis Patients: Results of a Six-Month Randomized Double-Blind Placebo-Controlled Pilot Study

by Stefano Murtas, Roberto Aquilani, Gianmarco Fiori, Roberto Maestri, Paolo Iadarola, Cristina Graccione, Rita Contu, Maria Luisa Deiana, Fabrizio Macis, Romina Secci, Antonella Serra, Mariella Cadeddu, Maura D’Amato, Paola Putzu, Mirella Marongiu and Piergiorgio Bolasco

Nutrients 2022, 14(17), 3492; https://doi.org/10.3390/nu14173492 - 25 Aug 2022

Cited by 2 | Viewed by 1933

Abstract

(1) Background: Chronic Kidney Disease (CKD) induces metabolic derangement of amino acid (AA) kinetics, eliciting severe damage to the protein anabolism. This damage is further intensified by a significant loss of AAs through hemodialysis (HD), affecting all tissues with a high metabolic turnover, such as the myocardium and body muscle mass. (2) Aim: to illustrate the effects of a novel AA mixture in boosting mitochondrial energy production. (3) Methods: A strict selection of 164 dialysis patients was carried out, allowing us to finally identify 22 compliant patients who had not used any form of supplements over the previous year. The study design envisaged a 6-month randomized, double-blind trial for the comparison of two groups of hemodialysis patients: eleven patients (67.2 ± 9.5 years) received the novel AA mix (TRG), whilst the other eleven (68.2

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10.5 years) were given a placebo mix that was indistinguishable from the treatment mix (PLG). (4) Results: Despite the 6-month observation period, the following were observed: maintenance of target hemoglobin values with a reduced need for erythropoiesis-stimulating agents in TRG > 36% compared to PLG (p < 0.02), improved phase angle (PhA) accompanied by an increase in muscle mass solely in the TRG group (p < 0.05), improved Left Ventricular Ejection Fraction (LVEF > 67%) in the TRG versus PLG group (p < 0.05) with early but marked signs of improved diastolic function. Increased sensitivity to insulin with greater control of glycemic levels in TRG versus PLG (p = 0.016). (5) Conclusions: the new AA mix seemed to be effective, showing a positive result on nutritional metabolism and cardiac performance, stable hemoglobin levels with the need for lower doses of erythropoietin (EPO), insulin increased cell sensitivity, better muscle metabolism with less loss of mass. Full article

(This article belongs to the Special Issue Nutritional and Hydration Status in Chronic Kidney Disease and Dialysis Patients)

10 pages, 612 KiB

Open AccessFeature PaperArticle

Feeding during Dialysis Increases Intradialytic Blood Pressure Variability and Reduces Dialysis Adequacy

by Elena Fotiadou, Panagiotis I. Georgianos, Vasilios Vaios, Vasiliki Sgouropoulou, Dimitrios Divanis, Apostolos Karligkiotis, Konstantinos Leivaditis, Michail Chourdakis, Pantelis E. Zebekakis and Vassilios Liakopoulos

Nutrients 2022, 14(7), 1357; https://doi.org/10.3390/nu14071357 - 24 Mar 2022

Cited by 4 | Viewed by 2407

Abstract

Whether hemodialysis patients should be allowed or even encouraged to eat during dialysis remains a controversial topic. This cross-over study aimed to evaluate the impact of feeding during dialysis on intradialytic blood pressure (BP) profile and dialysis adequacy in 26 patients receiving thrice-weekly, in-center hemodialysis. Over three consecutive mid-week dialysis sessions, intradialytic BP was monitored using the Mobil-O-Graph device (IEM, Stolberg, Germany). Blood samples were also obtained for the determination of the urea reduction ratio (URR). At baseline, patients underwent dialysis without the provision of a meal. In phases A and B, a meal with either high-protein (1.5 gr/kg of body weight) or low-protein (0.7 gr/kg of body weight) content was administered 1 h after the initiation of dialysis. The sequence of meals (high-protein and low-protein or vice versa) was randomized. Average intradialytic systolic BP (SBP) was similar on all three occasions. However, compared with baseline, the standard deviation (SD) (11.7 ± 4.1 vs. 15.6 ± 7.6 mmHg, p < 0.01), coefficient of variation (CV) (9.5 ± 3.7% vs. 12.4 ± 6.0%, p < 0.01) and average real variability (ARV) (9.4 ± 3.9 vs. 12.1 ± 5.2 mmHg, p < 0.01) of intradialytic SBP were higher in phase A. Similarly, compared with the baseline evaluation, all three indices of intradialytic SBP variability were higher in phase B (SD: 11.7 ± 4.1 vs. 14.1 ± 4.5 mmHg, p < 0.05; CV: 9.5 ± 3.7% vs. 11.1 ± 3.8%, p < 0.05; ARV: 9.4 ± 3.9 vs. 10.9 ± 3.9 mmHg, p < 0.05). Compared with dialysis without a meal, the consumption of a high-protein or low-protein meal resulted in a lower URR (73.4 ± 4.3% vs. 65.7 ± 10.7%, p < 0.001 in phase A and 73.4 ± 4.3% vs. 67.6 ± 4.3%, p < 0.001 in phase B, respectively). In conclusion, in the present study, feeding during dialysis was associated with higher intradialytic SBP variability and reduced adequacy of the delivered dialysis. Full article

(This article belongs to the Special Issue Nutritional and Hydration Status in Chronic Kidney Disease and Dialysis Patients)

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Review

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14 pages, 1764 KiB

Open AccessReview

Fluid Overload and Tissue Sodium Accumulation as Main Drivers of Protein Energy Malnutrition in Dialysis Patients

by Bernard Canaud, Marion Morena-Carrere, Helene Leray-Moragues and Jean-Paul Cristol

Nutrients 2022, 14(21), 4489; https://doi.org/10.3390/nu14214489 - 25 Oct 2022

Cited by 5 | Viewed by 2653

Abstract

Protein energy malnutrition is recognized as a leading cause of morbidity and mortality in dialysis patients. Protein–energy-wasting process is observed in about 45% of the dialysis population using common biomarkers worldwide. Although several factors are implicated in protein energy wasting, inflammation and oxidative stress mechanisms play a central role in this pathogenic process. In this in-depth review, we analyzed the implication of sodium and water accumulation, as well as the role of fluid overload and fluid management, as major contributors to protein–energy-wasting process. Fluid overload and fluid depletion mimic a tide up and down phenomenon that contributes to inducing hypercatabolism and stimulates oxidation phosphorylation mechanisms at the cellular level in particular muscles. This endogenous metabolic water production may contribute to hyponatremia. In addition, salt tissue accumulation likely contributes to hypercatabolic state through locally inflammatory and immune-mediated mechanisms but also contributes to the perturbation of hormone receptors (i.e., insulin or growth hormone resistance). It is time to act more precisely on sodium and fluid imbalance to mitigate both nutritional and cardiovascular risks. Personalized management of sodium and fluid, using available tools including sodium management tool, has the potential to more adequately restore sodium and water homeostasis and to improve nutritional status and outcomes of dialysis patients. Full article

(This article belongs to the Special Issue Nutritional and Hydration Status in Chronic Kidney Disease and Dialysis Patients)

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