Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients
| Autor: | Coen A. Stegeman, Wybe D. Kloppenburg, Roel M. Huisman, Paul E. de Jong, Pieter F. Vos, Ton K. Kremer Hovinga, Gerard Vastenburg |
|---|---|
| Přispěvatelé: | Groningen University Institute for Drug Exploration (GUIDE), Groningen Kidney Center (GKC), Translational Immunology Groningen (TRIGR) |
| Jazyk: | angličtina |
| Rok vydání: | 2004 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment KT/V THERAPY SERUM-ALBUMIN Animal science protein diet Renal Dialysis Internal medicine medicine Humans Urea Nutritional Physiological Phenomena prospective randomized study Dialysis protein equivalent of total nitrogen appearance Acidosis Transplantation Cross-Over Studies business.industry MORTALITY dialysis dose Middle Aged dietary protein intake medicine.disease Crossover study haemodialysis nutritional status Malnutrition Endocrinology CATABOLIC RATE SIZE Nephrology Kt/V Lean body mass Female Dietary Proteins Hemodialysis medicine.symptom Energy Metabolism business Follow-Up Studies Kidney disease |
| Zdroj: | Nephrology Dialysis Transplantation, 19(5), 1212-1223. Oxford University Press |
| ISSN: | 1460-2385 0931-0509 |
| Popis: | Background. Protein requirements in stable, adequately dialysed haemodialysis patients are not known and recommendations vary. It is not known whether increasing the dialysis dose above the accepted adequate level has a favourable effect on nutrition. The aim of this study was to determine whether prescribing a high protein diet and increasing the dose of dialysis would have a favourable effect on dietary protein intake and nutritional status in stable, adequately dialysed haemodialysis patients. Effects on hyperphosphataemia and acidosis were also studied.Methods. Patients were randomized to a high dialysis dose (HDD) group (target Kt/V-eq of 1.4) or a regular dialysis dose (RDD) group (target Kt/V-eq of 1.0). All patients were prescribed a high protein (HP) diet [1.3 g/kg of ideal body weight (IBW)/day] and a regular protein (RP) diet (0.9 g/kg/day), each during 40 weeks in a crossover design. In 50 patients, 23 in the HDD and 27 in the RDD group follow-up was greater than or equal to10 weeks. These patients, aged 56 15 years, were included in the analysis. Nutritional status was assessed by anthropometry, plasma albumin and a nutritional index.Results. Delivered Kt/V-eq in the HDD group (1.26 +/- 0.14) was significantly higher than in the RDD group (1.02 +/- 0.08). Protein intake estimated from total nitrogen appearance (PNA) measurements and food records (DPI) was significantly higher during the HP diet (PNA(IBW), 1.01 +/- 0.18 g/kg/day; DPIIBW, 1.15 +/- 0.18 g/kg/day) than during the RP diet (PNA(IBW), 0.90 +/- 0.14 g/kg/day; DPIIBW, 0.94 +/- 0.11 g/kg/day). Increasing the dialysis dose did not increase protein intake either during the HP or RP diet. Plasma albumin (41.9 +/- 3.0 g/l) lean body mass (107 +/- 15% of normal values) and the nutritional index did not differ between the dialysis dose groups or protein diets and remained stable overtime. Dry body weight (97 +/- 14%) and total fat mass increased over time in the HDD group, but remained stable in the RDD group suggesting an effect of dialysis dose on energy balance. There was no effect of the protein diets on dry body weight or total fat mass. Plasma phosphate levels and oral bicarbonate supplements were lower in the HDD group, but were comparable between the protein diets.Conclusions. Prescribing a HP diet resulted in a modest increase in actual protein intake, but increasing dialysis dose did not have a contributing effect. A HP diet or increasing the dialysis dose did not have a favourable effect on the nutritional status. A dietary protein intake of at least 0.9 g/kg IBW/day appears to be sufficient for adequately dialysed haemodialysis patients without overt malnutrition. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|