Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients.

Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001). As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.

Systemic inflammation May limit the effect of protein supplement on nutritional status in peritoneal dialysis.

BACKGROUND: Malnutrition and inflammation are highly prevalent and associated with poor outcomes in continuous ambulatory peritoneal dialysis (CAPD). Nutritional supplements are commonly used; however, presence of systemic inflammation could limit their effect. AIM: To evaluate the impact of systemic inflammation on nutritional status of CAPD patients receiving an oral protein supplement. METHODS: Prospective observational study; 34 malnourished patients (subjective global assessment; SGA) received both nutritional counseling and oral egg albumin-based protein supplement. During 6-month of follow-up, patients had monthly clinical, and quarterly biochemical and inflammation [interleukin 6 and high sensitivity C-reactive protein (hsCRP)] evaluations. According to baseline hsCRP, patients were classified in two groups: Inflammation (>3 mg/L) and No-inflammation (≤3 mg/L). RESULTS: Comparing baseline vs final, macronutrient intake and SGA increased in both groups, however, improvement of SGA was more marked in the No-inflammation group at the end of the study: 70% improved, 25% no change and 5% worsened (p = 0.001); whereas in the Inflammation group results were: 50% improved, 36% no change and 14% worsened (p = 0.03). Additionally, at final evaluation, serum albumin tended to increase more in the No-inflammation (3.0 ± 0.9 vs 3.4 ± 1.1 g/dL, p = 0.08) than in Inflammation group (2.8 ± 0.6 vs 3.0 ± 0.9 g/dL, p = 0.66), and body mass index significantly increased in No-inflammation group (20.3 ± 3.0 vs 21.6 ± 3.3 kg/m2, p < 0.001) but not in Inflammation group (21.9 ± 3.0 vs 22.5 ± 3.3 kg/m2, p = 0.09). CONCLUSIONS: The presence of systemic inflammation in malnourished CAPD patients seemed to limit the trend for improvement on nutritional status observed with counseling and oral egg albumin-based protein supplement in patients without inflammation.

Reliability and validity of a clinical competence test for dietitians caring patients with early chronic kidney disease.

The aim of the present study was to develop and validate a test to evaluate dietitian's clinical competence (CC) about nutritional care in patients with early chronic kidney disease (CKD). The study was conducted through five steps: (1) CC and its dimensions were defined; (2) test items were elaborated, and choice of response format and scoring system was selected; (3) content and face validity were established; (4) test was subjected to a pilot test and those items with inadequate performance were removed; (5) criterion validity and internal consistency for final validation were established. A 120-items test was developed and applied to 207 dietitians for validation. Dietitians with previous CKD training obtained higher scores than those with no training, confirming the test validity criterion. According to item analysis, Cronbach's α was 0⋅85, difficulty index 0⋅61 ± 0⋅22, discrimination index 0⋅26 ± 0⋅15 and inter-item correlation 0⋅19 ± 0⋅11, displaying adequate internal consistency.

Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients / La severidad del desgaste energético-proteico y la obesidad se relacionan independientemente con la mala calidad de vida en pacientes de diálisis peritoneal

Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status.Aim: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD.This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured.Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52–75), 55 (45–72), 46 (43–58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001).As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education. (AU)

El desgaste proteico-energético (DEP) y la mala calidad de vida relacionada con la salud (CVRS) se asocian de forma independiente con la morbimortalidad en diálisis peritoneal continua ambulatoria (DPCA). El DEP puede reducir la CVRS; sin embargo, planteamos la hipótesis de que la CVRS se ve afectada de forma independiente por los grados de DEP o por los criterios individuales del estado nutricional. Objetivo : Evaluar la CVRS de acuerdo a la gravedad de la DEP e indicadores del estado nutricional en DPCA.Este es un estudio transversal en 151 pacientes. Se empleó la evaluación global subjetiva (EGS) y el estado nutricional se clasificó como normal, DEP leve-moderada y DEP grave. La CVRS se evaluó mediante el uso del cuestionario Kidney Disease Quality of Life Short Form™, incluidos los componentes físicos (PCS), mentales (MCS) y de enfermedad renal (KDCS) y sus subescalas. Se midieron la ingesta dietética, las variables antropométricas y bioquímicas.El 46% de los pacientes tenía un estado nutricional normal, el 44% tenía DEP leve-moderada y el 10% DEP grave. En comparación con los pacientes bien nutridos, aquellos con DEP leve-moderada (p=0,06) y grave (p=0,005) tenían una puntuación de CVRS más baja (68 [52-75], 55 [45-72], 46 [43-58], respectivamente). Igualmente, la PCS, MCS y KDCS y sus subescalas tuvieron valores más bajos, conforme la DEP fue más severa. Los pacientes con obesidad e hipoalbuminemia tenían puntuaciones de CVRS general y de sus componentes significativamente más bajas que sus contrapartes. La ingesta dietética no se asoció con la calidad de vida. En el análisis multivariado la obesidad, el DEP (por EGS), la hipoalbuminemia y el bajo nivel educativo predijeron una mala CVRS (χ2 58,2; p<0,0001).En conclusión, la gravedad del DEP se relacionó con una peor CVRS, ya sea como puntuación global o en cada componente o subescala de los pacientes con DPCA. ... (AU)

Willingness to change diet and exercise behavior is associated with better lifestyle in dialysis patients close to a kidney transplant.

BACKGROUND & AIMS: Evidence suggests that multiple-behavior interventions (with a specialist) have a greater impact on public health than single-behavior interventions, particularly in a chronic patient. However, there is little understanding of some very basic principles concerning multiple health behavior change, especially in situations such as kidney transplantation, which requires a great willingness to change negative lifestyle behaviors to achieve intermediate and long-term success. We compared healthy lifestyles and nutritional status according to the willingness to change dietary and exercise behavior in dialysis patients from a living donor kidney transplant program. METHODS: 400 dialysis patients had a dietetic, anthropometric, protein-energy wasting [subjective global assessment (SGA)] and biochemical evaluation. Lifestyle was evaluated with an adapted instrument to measure lifestyle in chronic disease. Willingness to change behaviors was evaluated by the trans-theoretical model; 2 groups were formed: willingness to change dietary and exercise behaviors and unwillingness to change. RESULTS: Willingness to change dietary behavior was 50% and exercise 25%. Patients with willingness to change dietary and exercise behaviors had better healthy lifestyle scores, and higher frequency of healthy food consumption. Healthy lifestyle score (R2 = 0.37, p < 0.0001) was predicted by older age, higher educational degree, shorter time on dialysis, and the highest willingness to change dietary and exercise behaviors. CONCLUSIONS: Willingness to change dietary and exercise behaviors was associated with healthy lifestyle, as well as with higher frequency of healthy food consumption and with lower frequency of unhealthy food consumption.

Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients.

Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001). As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.

Clinical Taste Perception Test for Patients With End-Stage Kidney Disease on Dialysis.

OBJECTIVE: The aim of this study was to validate a direct taste perception test (TPT) and evaluate its performance in patients on dialysis. METHODS: This cross-sectional study was carried out in a tertiary-care hospital. A TPT was validated on 112 healthy subjects and applied on 43 patients on hemodialysis and 32 patients on peritoneal dialysis. All participants were presented a 10-mL sample to identify and rate intensity of primary tastes: sweet (sucrose 2%), sour (citric acid 0.1%), bitter (caffeine 0.06%), salty (sodium chloride 0.5%), and umami (sodium glutamate 0.25%). The internal consistency and repeatability of TPT was assessed by Cronbach's alpha and intraclass correlation coefficient. Chi-square and Mann-Whitney U tests were used to compare groups. RESULTS: TPT had Cronbach's alpha of 0.77. Intraclass correlation coefficient was 0.74 for sweet, P < .0001; 0.57 for salty, P = .001; 0.62 for sour, P < .0001; 0.78 for bitter, P < .0001; and 0.76 for umami, P < .0001. Compared with controls, patients on peritoneal dialysis were less able to identify sweet and umami tastes (P < .05) and marginally (P = .06) sour taste, whereas patients on hemodialysis were marginally (P = .06) less able to identify sweet and salty tastes. Bitter was not differently identified between groups. According to the visual analog scale (0-10), all patients on dialysis perceived sour taste less intensely than control subjects (P < .05). CONCLUSIONS: This TPT for patients on dialysis had adequate reliability to identify five primary tastes in a clinical setting. Except for bitter taste, perception of all the primary tastes was altered in patients on dialysis compared with control subjects. A broader use of this test would help identify taste alterations and implement strategies for malnutrition.

Pica en enfermedad renal crónica avanzada: revisión de la literatura / Pica in end-stage chronic kidney disease: Literature review

La pica como entidad individual en el paciente con enfermedad renal crónica (ERC) no ha sido ampliamente estudiada, a pesar de que se ha reportado una alta prevalencia en esta población, y de que las complicaciones propias de la pica (anemia, alteración en electrolitos, mala absorción de micro y macronutrientes y desnutrición) podrían verse exacerbadas en la ERC, lo cual limitaría alcanzar una mejor calidad de la terapia de remplazo renal. La ingesta de sustancias no calóricas y no nutricionales podría ser perjudicial por los efectos en la saciedad y en el descontrol metabólico/electrolítico, y por afectar la biocompatibilidad de los micronutrientes, toxinas y patógenos, lo que finalmente puede empeorar el estado de salud. En la práctica diaria es posible que la pica resulte subreportada debido a la vergüenza del paciente a reconocerlo, o el miedo a que dicho comportamiento pueda influir en su tratamiento. Adicionalmente, los clínicos, al no investigar la presencia de pica o sus complicaciones contribuyen a la falta de información acerca de la magnitud y la relevancia de este trastorno de la conducta alimentaria en la ERC

Pica is an individual entity in the patient with chronic kidney disease (CKD), which phenomenon has not been widely studied despite the high reported prevalence. Moreover, pica complications (anemia, altered electrolytes, poor absorption of micro and macronutrients and malnutrition) could be exacerbated in CKD and limit the quality of renal replacement therapy. The intake of non-caloric and non-nutritional substances could be harmful and cause effects on satiety and metabolic / electrolyte imbalance and modify the biocompatibility of micronutrients, toxins and pathogens worsening health status. In daily practice, pica could be under-reported because patient's shame to recognize it, or fear that such behavior influences their treatment. Additionally, clinicians who not investigate the presence of pica or its complications contribute to the lack of information about the magnitude and relevance of this problem in CKD

Pica in end-stage chronic kidney disease: Literature review. / Pica en enfermedad renal crónica avanzada: revisión de la literatura.

Pica is an individual entity in the patient with chronic kidney disease (CKD), which phenomenon has not been widely studied despite the high reported prevalence. Moreover, pica complications (anemia, altered electrolytes, poor absorption of micro and macronutrients and malnutrition) could be exacerbated in CKD and limit the quality of renal replacement therapy. The intake of non-caloric and non-nutritional substances could be harmful and cause effects on satiety and metabolic / electrolyte imbalance and modify the biocompatibility of micronutrients, toxins and pathogens worsening health status. In daily practice, pica could be under-reported because patient's shame to recognize it, or fear that such behavior influences their treatment. Additionally, clinicians who not investigate the presence of pica or its complications contribute to the lack of information about the magnitude and relevance of this problem in CKD.