[Nutritional status of pre-dialysis patients]. / Der Ernährungszustand von Prädialysepatienten.

INTRODUCTION AND AIM: Protein-energy malnutrition (PEM) is a well-known problem in the care of persons with chronic kidney disease (CKD). Continuous assessment of nutritional status (NS) is therefore recommended in dialysis care as well as in the care of pre dialysis patients. Subjective Global Assessment (SGA) is a multifactor, subjective method for assessment of a patients' NS. Reduced handgrip strength (HGS) is associated with PEM and considered to be a reliable nutritional parameter that reflects loss of muscle mass. The aim of this retrospective study was to analyse NS in pre dialysis patients with a focus on the significance of HGS. PATIENTS AND STUDY DESIGN: In this retrospective study HGS and NS assessed by SGA in 112 pre dialytic individuals were analysed. The patients' mean Glomerular Filtration Rate (GFR) was 14 (+/- 4) ml/min and their mean age was 63 (+/- 15) years. The patients were assessed consecutively from November 2001 to November 2003. Sixty-three percent of these patients were assigned a protein-restricted diet (PRD) 0.6-0.8g/kg/day. RESULTS AND CONCLUSIONS: Relatively few patients (13%) were classified as malnourished according to SGA but many reported fatigue, loss of appetite and reduced levels of physical activity. Few patients (6%) were underweight (BMI < 20), whereas 58% were overweight (BMI > 25). Patients on a PRD did not have impaired NS, compared to patients not on a PRD. Patients who had some degree of malnutrition tended to have reduced HGS. Among male patients, those with a lower level of physical activity tended to have lower HGS. Among the female patients, those who experienced loss of appetite and/or feeling of fatigue tended to have lower HGS. The pre dialysis patients had lower HGS compared to predicted norm for healthy subjects.

Twelve weeks of exercise training increases muscle function and walking capacity in elderly predialysis patients and healthy subjects.

Muscle function declines with age and progressive uraemia. We examined whether elderly predialysis patients could improve thigh muscle function, walking capacity, and functional mobility to the same extent as elderly healthy subjects when participating in 12 weeks of individual muscle endurance exercises for the thigh as well as in a low-intensive group programme. The uraemic exercise and comparison groups comprised 16 patients (age 76 +/- 7 years, glomerular filtration rate 18 +/- 5 ml/min) and 9 patients (age 72 +/- 6 years, glomerular filtration rate 16 +/- 5 ml/min), respectively. The healthy exercise and comparison groups comprised 18 subjects (age 75 +/- 7 years) and 5 subjects (age 79 +/- 4 years), respectively. Muscular strength, dynamic endurance, walking capacity, and functional mobility increased significantly in both the uraemic and the healthy exercise groups after 12 weeks of regular muscle endurance exercise training, whereas there was no significant change in static muscle endurance and quality of life in either group. None of the values changed for the uraemic comparison group nor the healthy comparison group during the observation period. Elderly predialysis patients had lower muscle function and mobility as compared with elderly healthy subjects, but were able to improve both after 12 weeks of exercise training to the same extent as elderly healthy subjects.