The relationship between lymphocyte subsets, nutritional status and tuberculin reactivity in continuous ambulatory peritoneal dialysis and hemodialysis patients.
Usta Mehmet,Ersoy Alpaslan,Ayar Yavuz,Budak Ferrah
International urology and nephrology
AIM:Skin test anergy is common in patients with uremia and during maintenance hemodialysis treatment. However, up to date only one study concerning skin test in peritoneal dialysis patients has focused on the issue. Our cross-sectional controlled study was conducted to analyze the correlation of purified protein derivative (PPD) test response with demographical features, nutritional parameters and the distribution of peripheral blood lymphocyte subsets in peritoneal dialysis and hemodialysis patients PATIENTS AND METHODS: Stable 30 hemodialysis (HD) patients (16 men, 14 women) and 30 continuous ambulatory peritoneal dialysis (PD) patients (17 men, 13 women) were included. Thirty healthy cases (15 men, 15 women) with a mean age of 32.4 ± 9.4 constituted the control group. RESULTS:In the HD group, 14 patients (46.6%) were PPD positive, and ın the PD group 16 patients (53.3%) were PPD positive. In the PPD-positive HD patients 64.2% (9/14), and in the PPD-positive PD patients 62.4% (10/16) had an induration of 10 mm or greater. In the control group, 21 of 30 patients (70%) were PPD positive. Comparison of both HD and PD groups with the control group showed significant differences in PPD reactivity (p < 0.01). Albumin levels were significantly high in the control groups (p < 0.01), and cholesterol levels were significantly high in the PD and the control groups (p < 0.05). Transferrin levels were significantly high in the PD (p < 0.01). The lymphocyte counts were significantly high in the control group compared to the HD patients (p < 0.05). The lymphocyte subset percentages CD19 were high in the control groups (p < 0.05), and CD16/56 was significantly high in the PD groups (p < 0.05). All the parameters were also similar between PPD-positive and -negative same groups. CONCLUSION:The prevalence of PPD positivity was lower in the PD and HD groups. The PPD test responses were not related to the peripheral lymphocyte counts, subsets and malnutrition parameters.
10.1007/s11255-020-02467-1
Serum albumin as a predictor of mortality in peritoneal dialysis: comparisons with hemodialysis.
Mehrotra Rajnish,Duong Uyen,Jiwakanon Sirin,Kovesdy Csaba P,Moran John,Kopple Joel D,Kalantar-Zadeh Kamyar
American journal of kidney diseases : the official journal of the National Kidney Foundation
BACKGROUND:Serum albumin level predicts mortality in dialysis patients and is used to assess their health status and the quality of delivered care. Whether the threshold level of serum albumin at which mortality risk increases in peritoneal dialysis (PD) patients is the same as for hemodialysis (HD) patients has not been studied. STUDY DESIGN:Observational cohort study of dialysis patients undertaken to determine the survival-predictability of serum albumin level in PD patients and compare it with that in HD patients. SETTING & PARTICIPANTS:130,052 dialysis patients (PD, 12,171; HD, 117,851) who received treatment in any of the 580 dialysis units owned by DaVita Inc between July 1, 2001, through June 30, 2006, followed up through June 30, 2007. PREDICTOR:Baseline and time-averaged serum albumin level (assayed using bromcresol green) and change in serum albumin level over 6 months. OUTCOME MEASURES:All-cause, cardiovascular, and infection-related mortality. RESULTS:PD patients with baseline serum albumin level <3.0 g/dL had a more than 3-fold higher adjusted risk of all-cause and cardiovascular mortality and 3.4-fold higher risk of infection-related mortality (reference group: serum albumin, 4.00-4.19 g/dL). Adjusted all-cause mortality was significantly lower in PD patients with a ≥0.3-g/dL increase in serum albumin level over 6 months and significantly higher in those for whom it decreased by ≥0.2 g/dL (reference group: serum albumin change, +0.1 to -0.1 g/dL). A significant increase in death risk was evident for HD patients with serum albumin level <4.0 g/dL, but at <3.8 g/dL for PD patients. For each albumin category, overall death risk for PD patients was lower than for HD patients (reference group: HD patients with serum albumin of 4.00-4.19 g/dL). LIMITATIONS:Study can identify associations only without attribution of causality and residual confounding cannot be excluded. CONCLUSIONS:Serum albumin predicts all-cause, cardiovascular, and infection-related mortality in both PD and HD patients. However, the threshold at which risk of death increases varies by dialysis modality, and this difference should be considered by agencies or organizations that set quality standards.
10.1053/j.ajkd.2011.03.018
Relationship between geriatric nutritional risk index and subpopulation lymphocyte counts in patients undergoing hemodialysis and peritoneal dialysis.
Kang Gyong Hoon,Kim Ye Na,Shin Ho Sik
Renal failure
We investigated the relationship between geriatric nutritional risk index (GNRI) and subpopulation lymphocyte counts (SLCs) in hemodialysis (HD) and peritoneal dialysis (PD) patients and evaluated whether they can be helpful in the diagnosis of malnutrition in these patients. We examined the GNRI and SLCs of 50 HD patients (mean: 55.8 ± 12.7 years; 28 men and 22 women) and 16 Continuous Ambulatory Peritoneal Dialysis (CAPD) patients (mean: 49.8 ± 14.5 years; 10 men and six women). The GNRI is calculated based on the serum albumin level, dry weight, and ideal body weight and uses the following equation: GNRI = [14.89 × albumin (g/dL)] + [41.7 × (weight/ideal body weight)]. SLCs were evaluated using flow cytometry. T-tests and χ tests were performed to compare the two groups. Logistic regression analysis was performed for predicting malnutrition in dialysis patients. The average GNRI value was 100.1 ± 8.4 in HD patients and 99.2 ± 8.1 in PD patients, and no significant differences in GNRI or SLC were observed between the two groups. SLCs were higher in patients with higher GNRI (GNRI ≥ 100) although there was no statistical difference. Logistic regression for predicting malnutrition according to GNRI revealed that age, female sex, and CD19 counts predicted malnutrition in HD and PD patients. These results suggest that GNRI and SLCs (especially CD19 count) may be significant nutritional markers in these patients.
10.3109/0886022X.2015.1128234
Nutritional issues in peritoneal dialysis patients: how do they differ from that of patients undergoing hemodialysis?
Mehrotra Rajnish
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation
It is important to understand the unique aspects vis-à-vis protein-energy wasting for patients undergoing PD. As a result of obligatory protein losses with the therapy, the serum albumin levels of patients undergoing PD are lower, as is the threshold serum albumin at which the risk for death is increased. Consequently, it is prudent to consider a lower threshold for serum albumin for the diagnosis of protein-energy wasting for patients undergoing PD. Likewise, it is important to consider the energy intake from obligatory nutrient absorption in the form of carbohydrates when estimating total energy intake (diet and dialysate) when evaluating patients for protein-energy wasting. The continuous nature of PD also has important therapeutic implications for protein-energy wasting. Such patients are more likely to have a complete correction of metabolic acidosis, and glucose absorption from the peritoneal dialysate has a protein-sparing effect, allowing some patients to maintain neutral nitrogen balances in the face of suboptimal protein intake. In contrast, clinical trials of amino-acid-based PD solutions have not met expectations and cannot be recommended for routine use for treatment of protein-energy wasting. In conclusion, it is important to consider these unique nutritional considerations when providing care to patients undergoing PD.
10.1053/j.jrn.2013.01.031
Energy balance in haemodialysis and peritoneal dialysis patients assessed by a 7-day weighed food diary and a portable armband device.
Bovio G,Montagna G,Brazzo S,Piazza V,Segagni S,Cena H
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association
BACKGROUND:Energy balance (EB) is important when assessing nutritional status. EB has never been assessed in haemodialysis (HD) and peritoneal dialysis (PD) patients. The present study aimed to assess weekly EB in these patients. METHODS:This clinical cross-sectional study was conducted for 7 days in eight HD and eight PD patients. Nutritional status was assessed by anthropometry, bioelectrical impedance analysis and biochemical markers. Energy intake (EI per day) and total energy expenditure (TEE per day) were determined by a 7-day weighed food diary and a portable armband device, respectively. RESULTS:No significant differences in age, body mass index, fat free mass (FFM), parathyroid hormone were found between the two groups. EB was calculated by subtracting TEE per day from EI per day. EB was negative in HD {-1347 (1276) kJ day(-1) [-322 (305) kcal day(-1) ]}, as well as in PD patients {-427 (5338) kJ day(-1) [-102 (395) kcal day(-1) ]}. TEE per day was positively correlated with EI per day, prealbumin, FFM. EI per day was positively correlated with prealbumin. C-reactive protein was negatively correlated with TEE and FFM (P < 0.05). EB showed a positive correlation with EI per day (P = 0.012) and a negative trend with TEE. CONCLUSIONS:HD and PD patients have a negative EB and are at risk of malnutrition. Inflammatory status determines a lower EI per day and a reduction in TEE per day. The most important parameter in determining EB in HD and PD patients is EI per day. This topic deserves further investigation to better understand the mechanisms of impaired EB with respect to preserving patients' nutritional status.
10.1111/j.1365-277x.2012.01291.x
Peritoneal dialysis patients have higher prevalence of gastrointestinal symptoms than hemodialysis patients.
Salamon Karen,Woods Julie,Paul Eldho,Huggins Catherine
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation
OBJECTIVE:Malnutrition is common in dialysis patients and is attributed to decreased food intake, and/or chronic systemic inflammation linked to dialysis-related comorbidities and complications. This study aimed to determine the prevalence of gastrointestinal (GI) symptoms in dialysis patients and whether this impacts food intake. DESIGN:Cross-sectional study. SETTING:Tertiary teaching hospital. PARTICIPANTS:All consenting hospital peritoneal dialysis (PD) and hemodialysis (HD) patients. METHODS:Patients were interviewed by a dietitian regarding the prevalence and impact of GI symptoms (nausea, vomiting, bloating, early satiety, diarrhea, heartburn, fatigue, and weight changes). Serum levels of albumin were measured, and the use of medication known to cause GI symptoms was recorded. MAIN OUTCOME MEASURE:Presence of GI symptoms. RESULTS:The PD (n = 122) and HD (n = 172) groups were similar in age, gender, and presence of diabetes. Serum albumin levels were lower for those on PD compared with HD (3.2 vs. 3.5 g/dL, P < .001). Eighty-five percent of the patients on PD reported at least 1 GI symptom, compared with 51% on HD. Compared with HD, more PD patients reported that GI symptoms were related to the onset of dialysis (55% vs. 12%, P < .001). A greater number of PD patients (compared with HD patients) reported a decrease in food intake (53% vs. 14%, P < .001) and that they had attempted dietary changes to alleviate symptoms (34% vs. 9%, P < .001). CONCLUSION:These results should influence dietetic educational practice. In addition to the provision of adequate protein and energy, dialysis patients should be counselled regarding the management of GI symptoms and monitored for the prevalence and severity of these symptoms.
10.1053/j.jrn.2012.02.007
Comparison of malnutrition in hemodialysis and peritoneal dialysis patients and its relationship with echocardiographic findings.
Naini Afsoon Emami,Karbalaie Alireza,Abedini Mokhtar,Askari Gholamreza,Moeinzadeh Firouzeh
Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences
BACKGROUND:Malnutrition is common in patients with end-stage renal disease (ESRD) who on peritoneal dialysis (PD) or hemodialysis (HD). This study aimed to compare the frequency distribution of malnutrition in HD and PD patients and its relationship with echocardiographic findings. MATERIALS AND METHODS:This is a case-control study. Using the simple random sampling, 109 patients were selected among HD and PD patients based on the inclusion criteria. HD and PD groups included 55 and 54 patients, respectively. The malnutrition-inflammation score (MIS) index was used to assess malnutrition. Echocardiography was performed by a cardiologist. All the data were analyzed by SPSS version 18. RESULTS:In this study, 79.6% (43 patients) were in the PD group with MIS <9 (no malnutrition to mild malnutrition) and 20.4% (11 patients) with 9 ≤ MIS ≤ 18 suffered from moderate malnutrition. In the HD group, 72.7% (forty patients) had MIS < 9, 25.5% (14) had 9 ≤ MIS ≤ 18, and 1.8% (one patient) with MIS > 18 suffered from severe malnutrition ( = 0.74). There was no significant relationship between MIS and echocardiographic findings in PD patients ( > 0.05). In the HD group, there was no significant relationship between MIS and echocardiographic findings ( > 0.05), except for aortic and mitral valve insufficiencies ( < 0.05). CONCLUSION:The findings of this study show 27.3% of HD patients had moderate to severe malnutrition. There was a statistically significant relationship between MIS index and aortic and mitral valve insufficiencies in HD patients.
10.4103/1735-1995.189695
Comparative study on the efficacy of peritoneal dialysis and hemodialysis in patients with end-stage diabetic nephropathy.
Xu Xiao-Dong,Han Xue,Yang Yi,Li Xu
Pakistan journal of medical sciences
Objective:Diabetic nephropathy is a serious threat to human health, and its incidence is on the rise. End-stage diabetic nephropathy (ESDN) requires extra investigation due to its complexity and severity, as well as serious concurrent diseases. Our objective was to compare the efficacy of hemodialysis (HD) and peritoneal dialysis (PD) in the treatment of ESDN. Methods:Clinical data of 84 patients with ESDN admitted to our hospital from June 2016 to June 2018 were retrospectively analyzed. The patients were divided into an HD group that received hemodialysis and a PD group that received peritoneal dialysis. Their general conditions, biochemical indicators, residual renal function and incidence of complications were recorded and compared between the two groups. Results:(1) No significant difference in diastolic blood pressure, systolic blood pressure, body weight, or urine output was detected between the two groups at the beginning of dialysis (P>0.05). (2) Compared to the PD group, the HD group had significantly lower total cholesterol (TC) and triglyceride (TG) (P<0.05), and significantly higher total protein (TP) and albumin (ALB) after treatment (P<0.05). (3) The two groups also showed significant difference in residual renal function after treatment (P<0.05). (4) The HD group had significantly higher systolic pressure than the PD group after treatment (P<0.05). And more cases of infection were observed in the PD group than the HD group (P<0.05). Conclusion:Both HD and PD are used for treatment of ESDN, and can achieve similar calcium and phosphorus control. Compared to HD, PD has less adverse effect on hemodynamics and better preserves residual renal function, but is more likely to cause malnutrition and disorders of lipid metabolism. Therefore, choice of dialysis method should be based on specific conditions of each patient.
10.12669/pjms.36.7.2901
The relationship between malnutrition and quality of life in haemodialysis and peritoneal dialysis patients.
Günalay Serkan,Öztürk Yasemin Kiliç,Akar Harun,Mergen Haluk
Revista da Associacao Medica Brasileira (1992)
BACKGROUND:One of the most important factors affecting the quality of life of chronic kidney disease (CKD) patients is nutrition. Prevention of malnutrition increases patients' quality and length of life. In this study, we aimed to determine the frequency of malnutrition, quality of life, and the relationship between them in patients with end-stage renal disease (ESRD). METHOD:The study was conducted with a total of 60 CKD patients including 50 haemodialysis patients and 10 peritoneal dialysis patients. Patients' data associated with socio-demographics, body mass index (BMI), waist circumference, triceps skin-fold thickness (TSFT), pre-dialysis systolic and diastolic blood pressure, Kt/V and urea reduction ratio (URR) values, laboratory parameters, Mini-Nutritional Assessment-Short Form (MNA-SF) and European Quality of Life 5-Dimensions (EQ5D) scale were recorded. FINDINGS:Of the total 60 patients; 27 were male (45%), 33 were female (55%), 83.3% were receiving haemodialysis treatment (HD), and 16.7% were receiving peritoneal dialysis treatment (PD). The mean MNA-SF score was 10.4 ± 2.8 in the HD group and 10.5 ± 2.9 in the PD group; there was no difference between the scores of the HD and PD groups. The mean EQ5D score was 0.60 ± 0.29 in the HD group and 0.68 ± 0.33 in the PD group, no significant difference was found between the HD group and the PD group. The quality of life was found lower in malnourished group (p=0.001). CONCLUSION:The quality of life needs to be increased by early diagnosis and treatment of malnutrition in patients at risk.
10.1590/1806-9282.64.09.845