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

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

Deadline for manuscript submissions: 15 July 2024 | Viewed by 5871

Special Issue Editors

Prof. Dr. Guillermina Barril

E-Mail Website
Guest Editor
Nephrology Department, Hospital Universitario La Princesa, 28006 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 PEW increases with the progression of CKD, although the presence of PEW is detected more frequently in dialysis and with a different nutritional profile depending on whether the patient with CKD is on hemodialysis or peritoneal dialysis.

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

In the hemodialysis patient, protein loss is generally not going to be a problem, but the different hemodialysis techniques entail energy consumption that must be carefully monitored, although there may be mixed forms of malnutrition in hemodialysis or peritoneal dialysis, mainly if there is inflammation.

The different hemodialysis schemes (incremental, hemodiafiltration online, HFR, daily HD, or hemodialysis with high cut-off) can modify the protein and fundamental energy requirements of patients.

Preventing PEW, correcting inflammation, and adapting the different dialysis schemes together with nutritional intervention with oral nutritional supplements or intradialytic parenteral nutrition in hemodialysis, and the use of protein modules or complete formula without forgetting the supplementation in peritoneal dialysis bags, make the area of nephro-nutrition necessary within the integral care of patients in renal replacement therapy with dialysis. 

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

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

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

Published Papers (3 papers)

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Research

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 - 08 Dec 2023
Viewed by 1082
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 on 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
Viewed by 1812
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 on 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 3 | Viewed by 2327
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 on Dialysis)
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