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Long-term oral nutrition supplementation improves outcomes in malnourished patients with chronic kidney disease on hemodialysis.
Sezer, S, Bal, Z, Tutal, E, Uyar, ME, Acar, NO
JPEN. Journal of parenteral and enteral nutrition. 2014;(8):960-5
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Abstract
BACKGROUND There is no consensus on the type, time of initiation, or duration of use of enteral nutrition in patients with chronic kidney disease (CKD). This study aimed to compare the effects of a renal-specific oral nutrition supplement (RS-ONS) and a standard recommended nutrition regime on biochemical and nutrition markers in malnourished patients with CKD on hemodialysis. METHODS Sixty-two malnourished patients with CKD, divided into experimental (RS-ONS; n = 32; mean [SD] age, 62.0 [11.3] years; 55.2% female) and control (CON; n = 30; mean [SD] age, 57.2 [12.3] years; 31% female) groups, were evaluated for anthropometric, biochemical, and inflammatory parameters. RESULTS Mean (SD) serum albumin levels were significantly increased in the RS-ONS group from 3.5 (0.3) g/dL at baseline to 3.7 (0.2) g/dL at 6 months (P = .028). Significantly fewer patients had serum albumin levels of <3.5 g/dL after month 6. Dry weight of patients significantly increased in the RS-ONS but decreased in the CON groups (P < .001 for each). Percent change from baseline revealed negative results for bioelectrical impedance analysis (P < .001) in the CON group. Malnutrition inflammation score at 6 months (P = .006) and erythropoietin (EPO) dose requirements were higher in the CON group (P = .012). CONCLUSIONS Our findings indicate that consuming RS-ONS improves serum albumin and anthropometric measures, as well as reduces EPO dose, in patients with CKD.
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Increased energy intake in hip fracture patients affects nutritional biochemical markers.
Gunnarsson, AK, Akerfeldt, T, Larsson, S, Gunningberg, L
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 2012;(3):204-10
Abstract
BACKGROUND AND AIMS We have previously shown that nutritional guidelines decreased the incidence of pressure ulcers in hip fracture patients. In the present study, we evaluate whether the nutritional biochemical markers S-IGF-1 (Insulin-like Growth Factor 1), S-Transthyretin and S-Albumin are affected by patients' energy intake, and whether the markers are useful as predictors of postoperative complications. MATERIAL AND METHODS Quasi-experimental design, with one intervention and one control group, as well as pre- and post-study measurements. Eighty-eight hip fracture patients were included: 42 in the control group and 46 in the intervention group. The control group received regular nutritional support pre- and postoperatively, while the intervention group received nutritional support that followed new, improved clinical guidelines from admission to five days postoperatively. S-Albumin, S-Transthyretin, C-Reactive Protein (S-CRP) and S-IGF-1 were analysed at admission and five days postoperatively as well as complications like pressure ulcer and infection. RESULTS The intervention group had a significantly higher energy intake; for example, 1636 kcal versus 852 kcal postoperative day 1. S-IGF-1 levels decreased significantly in the control group, while no decrease in the intervention group. S-Albumin and S-Transthyretin decreased and S-CRP increased significantly in both groups, indicating that those markers were not affected short-term by a high-energy intake. There was no correlation between short-term post-operative complications and S-IGF-1, S-Transthyretin or S-Albumin at admission. CONCLUSION The results of our study showed that S-IGF-1 can be used as a short-term nutritional biochemical marker, as it was affected by a five-day high-energy regimen. However, neither S-IGF-1, S-Transthyretin or S-Albumin were useful in predicting postoperative complications within five days postoperatively.
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[Changes of the concentration of serum ischemia modified albumin and high sensitivity C-reactive protein in type 2 diabetic patients with retinopathy].
Jia, ZT, Liu, CY, Li, H
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology. 2009;(9):805-8
Abstract
OBJECTIVE To explore the changes of the concentration of serum ischemia modified albumin (IMA) and high sensitivity C-reactive protein (hs-CRP) in type 2 diabetic patients with retinopathy (DR). METHODS The concentration of serum IMA and hs-CRP in DR patients were determined by ELISA and rate nephelometry and compared with those in 83 no-DR (NDR) patients and 72 controls. The concentration of serum IMA and hs-CRP in 40 proliferative diabetic retinopathy (PDR) patients were compared with those in 39 no-PDR (NPDR) patients. Data was evaluated using analysis of PPMS version 1.5.Results are expressed as means + or - standard deviation of the mean. Statistical comparisons were performed by student's t-test or one-way analysis of variance followed by Dunnett's multiple comparison test and the means compared each other using q test. RESULTS The serum IMA and hs-CRP concentration in DR patients were (46.51 + or - 13.29) microg/L, (4.27 + or - 2.24) mg/L. The serum IMA and hs-CRP concentration in NDR patients were (25.47 + or - 9.33) microg/L, (2.96 + or - 1.84) mg/L. The serum IMA and hs-CRP concentration in controls were (15.36 + or - 4.27) microg/L, (1.86 + or - 0.97) mg/L. The serum IMA and hs-CRP concentration in PDR patients were (54.72 + or - 15.61) microg/L, (6.34 + or - 3.53) mg/L. The serum IMA and hs-CRP concentration in NPDR patients were (38.35 + or - 11.27) microg/L, (3.28 + or - 1.77) mg/L. The serum IMA and hs-CRP concentration were significantly higher in DR patients than those in controls and NDR patients, the serum IMA and hs-CRP concentration in NDR patients were significantly higher than those in controls (F = 197.124, 34.561;q = 5.41-27.34; P < 0.01); the serum IMA and hs-CRP concentration were significantly higher in PDR patients than those in NPDR patients (t = 5.46, 4.89; P < 0.01); there was significant positive correlation between serum IMA concentration and hs-CRP concentration in DR patients (r = 0.617, P < 0.01). CONCLUSION The serum IMA and hs-CRP concentration were significantly high in DR patients, and were positively associated with the seriousness of DR, which may contribute to the development of DR.
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Concentrations of branched amino acids: isoleucine, valine, leucine in serum of hemodialysis patients during one-year observation.
Bednarek-Skublewska, A, Swatowski, A, Wawrzycki, S, Baranowicz-Gaszczyk, I, Ksiazek, A
Annales Universitatis Mariae Curie-Sklodowska. Sectio D: Medicina. 2002;(2):322-9
Abstract
Malnutrition is commonly reported in haemodialysis patients (HD pts) and is multifactorial in origin. Previous studies indicated a possible relationship between plasma levels of branched-chain amino acids (BCAA): isoleucine, leucine, valine and nutritional status of HD pts. The BCAA have important influence on metabolism of energy in skeletal muscles, in addition the leucine makes easy the synthesis of protein. In the present investigation we evaluated some parameters of nutritional state and the concentration of branched-amino acids in haemodialysis patients during one-year observation. Sixty-seven patients undergoing haemodialysis were assessed in the first study (study I), after 12 months this assessment was repeated in 70 patients (study II). Blood was drawn before the midweek dialysis session. Morphology, plasma albumin concentration and urea for KT/V calculation were determined by routine methods. Branched amino acids were measured by chromatography method with amino acid analyser AAA 400, using a lithium-citric buffer system. The plasma amino acid pattern was measured in the study group and compared with 20 healthy persons. Mean amino acids concentration observed in both study groups was significantly lower than in the control group. Mean concentration of BCAA was also lower than in control group. There was a small negative correlation between albumin concentrations and the length of dialysis therapy. There were significant positive correlations between: total amino acids, branched amino acids as well as albumin, especially in study II.
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Changes of serum albumin and C-reactive protein are related to changes of interleukin-6 release by peripheral blood mononuclear cells in hemodialysis patients treated with different membranes.
Memoli, B, Minutolo, R, Bisesti, V, Postiglione, L, Conti, A, Marzano, L, Capuano, A, Andreucci, M, Balletta, MM, Guida, B, et al
American journal of kidney diseases : the official journal of the National Kidney Foundation. 2002;(2):266-73
Abstract
Protein malnutrition, a condition associated with an albumin concentration less than 3.5 g/dL, has been shown to be a major risk factor for increased mortality in hemodialysis patients. The aim of this cross-over study was to evaluate the relationship between the type of membrane adopted and serum albumin changes by measuring peripheral blood mononuclear cells (PBMC) interleukin-6 (IL-6) release, serum albumin, and plasma concentrations of C-reactive protein (CRP) in 18 patients dialyzed with different membranes. During the study, all patients were dialyzed with cuprophan (CU), synthetically modified cellulosic (SMC) membrane (a new cellulosic membrane with lesser complement activation), and cellulose diacetate (CD) membrane, and have served as their own controls. IL-6 spontaneous release by PBMC resulted after 3 months of SMC (436.2 +/- 47.4 pg/mL) significantly (P < 0.05) reduced as compared with CU (569.3 +/- 24.5 pg/mL). This effect was more evident after 6 months of dialysis with SMC (220 +/- 35.3 pg/mL, P < 0.01 versus CU and versus 3 months of SMC). The passage to CD membrane was followed by a progressive new increase in the IL-6 PBMC release (332.3 +/- 30.7 after 3 months, and 351.2 +/- 35.8 pg/mL after 6 months, respectively) that, however, remained significantly (P < 0.05) lower than CU. The behavior of CRP plasma levels resembled that of IL-6 PBMC release (23.3 +/- 4.7 in CU, 11.0 +/- 2.1 after 3 months in SMC, and 7.9 +/- 1.5 after 6 months in SMC, respectively). IL-6 release values were positively correlated with circulating levels of CRP (r = 0.3264, P < 0.002). Serum albumin increased after 6 months of dialysis with SMC membranes (3.25 +/- 0.09 g/dL in CU and 3.64 +/- 0.07 g/dL in SMC, P < 0.05). When the patients were switched to CD, serum albumin showed a slight, though not statistically significant, decrease. Serum albumin concentrations negatively correlated with both IL-6 release values (r = -0.247, P < 0.05) and CRP plasma levels (r = -0.433, P < 0.001). In conclusion, our data clearly show that a significant relationship exists between biocompatibility of the membranes and serum albumin changes; serum albumin levels, in fact, are negatively correlated with the PBMC spontaneous IL-6 release values and CRP circulating levels.
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Vitamin D deficiency is implicated in reduced serum albumin concentrations in patients with end-stage renal disease.
Yonemura, K, Fujimoto, T, Fujigaki, Y, Hishida, A
American journal of kidney diseases : the official journal of the National Kidney Foundation. 2000;(2):337-44
Abstract
The mortality rate in hemodialysis patients remains extremely high, and reduced serum albumin concentration resulting from malnutrition is the strongest predictor of mortality and morbidity. Several inflammatory cytokines involved in malnutrition, including interleukin-1, interleukin-6, and tumor necrosis factor-alpha, are modulated by 1,25-dihydroxyvitamin D(3) [1,25-(OH)(2)D(3)], of which synthesis is impaired in end-stage renal disease. We evaluated whether 1,25-(OH)(2)D(3) deficiency might be involved in reduced serum albumin concentrations. Fifty-one predialysis uremic patients about to begin hemodialysis therapy were divided into groups with serum 1,25-(OH)(2)D(3) concentrations less than 18 pg/mL (low-D(3) group; n = 39) and concentrations of 18 pg/mL or greater (normal-D(3) group; n = 12). Serum albumin concentrations before the initiation of hemodialysis treatment were compared between the two groups. Furthermore, the effect of supplementation with active forms of vitamin D during 4 months of hemodialysis treatment on serum albumin concentrations was retrospectively evaluated in the low-D(3) group. Serum albumin concentrations in the low-D(3) group were significantly less than those in the normal-D(3) group (3.58 +/- 0. 50 versus 3.82 +/- 0.10 g/dL; P = 0.034). Considering all patients, a significant positive correlation between serum concentrations of albumin and 1,25-(OH)(2)D(3) was noted (r = 0.417; P = 0.0023). Supplementation with active forms of vitamin D significantly increased serum albumin concentrations in the low-D(3) group from 3. 61 +/- 0.12 to 3.79 +/- 0.13 g/dL (P = 0.0067). These findings indicate that reductions in serum albumin concentrations may be attributed, at least in part, to vitamin D deficiency in patients with end-stage renal disease.