Assessment of Nutritional Status and Metabolic Syndrome in Peritoneal Dialysis Patients: A Pilot Study

Nilüfer Acar Tek, Nevin Şanlıer, Gamze Akbulut, Kürşad Öneç, Yasemin Erten

Abstract


Aim:Nutritional deficiencies and metabolic syndrome (MS) is challenge in chronic kidney disease patients with peritoneal dialysis(PD). This study was planned in order to assess the nutritional status and metabolic syndrome in PD patients.

Methods:This study was performed on clinically stable patients that were undergoing PD therapy. Energy and nutrient intakes were determined with consequently three days dietary record.  The statement of MS was identified according to MS criteria adopted for PD patients.

Results:The prevalence of MS was found 64.3%. The mean duration of PD in with-MS(35.4±25.23mo.) was lower than without-MS(44.3±30.99mo.) (p>0.05). Patients with MS had significantly greater systolic/diastolic blood pressure and lower high-density-lypoprotein cholesterol levels (HDL-C) (p<0.05). According to the body mass index (BMI), the 83.3% of patients’ with-MS and 30% without-MS were found overweight and body fat mass was significant higher in patients with-MS(p<0.05). The mean daily protein intakes per kilograms of body weight determined lower with-MS patients (0.8±0.25g/kg) than without-MS (0.9±0.29 g/kg).

Conclusion: The prevalence of MS is remarkably high. The daily dietary energy and protein intakes were found under the recommended levels. Inadequate energy and protein intake increase loss of muscle mass and also excessive energy intake leads to obesity. Monitoring of nutritional status of PD patients is important both in prevention and progression of MS. 


Keywords


Peritoneal dialysis, food consumption, metabolic syndrome, body composition, nutritional status.

References


Barclay L: Metabolic syndrome highly prevalent in dialysis patient. Hemodial Int 2007;11:86-95.

Li PK, Kwan BC, Ko GT, Chow KM, Leung CB, Szeto CC: Treatment of metabolic syndrome in peritoneal dialysis patients. Perit Dial Int 2009;29(suppl 2):149–52.

Rasić S, Hadzović-Dzuvo A, Rebić D, Uncanin S, Hadzić A, Mujaković A, Kulenović I: The metabolic syndrome in patients on peritoneal dialysis: prevalence and influence on cardiovascular morbidity. Bosn J Basic Med Sci 2010;10:3-7.

Borazan A, Binici DN, Öztürk Y: Periton diyalizi hastalarında NCEP-ATP III ve IDF’ye göre metabolik sendrom sıklığı. Genel Tıp Dergisi 2011;21: 89-94.

Nath RK, Mridha MU, Sarker KR, Mollah FH, SFerdousi S, Rahman M: Metabolic Syndrome in Chronic Kidney Disease Patients. Dinajpur Medical College Journal 2012;5:34-8.

Chen J, Muntner P, Hamm LL, Jones DW, Batuman V, Fonseca V, Whelton PK, He J: The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med 2004;140:167-74.

Park SH, Lindholm B: Definition of metabolic syndrome in peritoneal dialysis. Perit Dial Int 2009;29:137-44.

Kramer HJ, Saranathan A, Luke A, Durazo-Arvizu RA, Guichan C, Hou S, Cooper R: Increasing body mass index and obesity in the incident ESRD population. J Am Soc Nephrol. 2006;17:1453-9.

Singh AK, Kari JA: Metabolic syndrome and chronic kidney disease. Curr Opin Nephrol Hypertens 2013;22:198-203.

Gobal F, Deshmukh A, Shah S, Mehta JL: Triad of metabolic syndrome, chronic kidney disease, and coronary heart disease with a focus on microalbuminuria death by overeating. J Am Coll Cardiol 2011;57:2303-8.

Feldeisen SE, Tucker KL: Nutritional strategies in the prevention and treatment of metabolic syndrome. Appl Physiol Nutr Metab 2007;32:46-60.

Lægreid IK, Aasarød K, Bye A, Leivestad T, Jordhøy M: The impact of nutritional status, physical function, comorbidity and early versus late start in dialysis on quality of life in older dialysis patients. Ren Fail 2014;36:9-16.

Holmes, CJ: Reducing Cardiometabolic Risk in Peritoneal Dialysis Patients: Role of the Dialysis Solution Journal of Diabetes Science and Technology 2009;3:1472-80.

Wiesen K, Mindel G: Dialysis, in nutrition and health. Nutr Kidney Dis 2008;3:231–62.

Akbulut G, Sanlıer N, Inal S., Acar Tek N, Öneç K, Erten Y: Daily dietary energy and macronutrient intake and anthropometric measurements of the peritoneal dialysis patients. Renal Failure 2013; 35:56–61.

Rakıcıoğlu N, Tek Acar N, Ayaz A, Pekcan G: Food and Nutrition Photo Catalog: dimensions and quantities. 6th edit. Ankara: Ata Ofset Typography; 2016.

BeBiS:Nutrition Data Base Software. The German Food Code and Nutrient Data Base (BLS II.3,1999) with additions from USDA-sr and other sources, Istanbul, Turkey2004;1-50.

K/DOQI:National Kidney Foundation. Clinical practice recommendations for peritoneal dialysis adequacy. Am J Kidney Dis 2006;48:131-58.

Lohman TG, Roche AF: Martorell R,(eds.) Anthropometric Standardization Reference Manual. Champaign, IL: Kinetics Books 1988.

Crepaldi C, Soni S, Chionh CY, Wabel P, Cruz DN, Ronco C:Application of body composition monitoring to peritoneal dialysis patients. Contrib Nephrol 2009;163:1-6.

Friedewald, WT, Levy RI, Fedickson DS: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of reparative ultracentrifuge. Clin. Chem 1972;18:499–502.

Li PKT, Kwan BCK, Szeto CC, Ko GT: Metabolic syndrome in peritoneal dialysis patients. Nephrol Dial Transplant Plus 2008;4:206-14.

Szeto CC, Kwan BC, Chow KM, Leung CB, Cheng MS, Law MC, Li PK: Metabolic Syndrome in Peritoneal Dialysis Patients: Choice of Diagnostic Criteria and Prognostic Implications. Clin J Am Soc Nephrol 2014;9:779–87.

Sagun G, Kantarci G, Mesci B, Gungor S, Turkoglu F, Yorulmaz E, Oguz A: Frequency of Cardiovascular Risk Factors and Metabolic Syndrome in Patients with Chronic Kidney Disease. Clinical Medicine & Research 2010;8:135-41.

Naylor HL, Jackson H, Walker GH, Macafee S, Magee K, Hooper L, Stewart L, MacLaughlin HL: Renal Nutrition Group of the British Dietetic Association; British Dietetic Association. British Dietetic Association evidence-based guidelines for the protein requirements of adults undergoing maintenance haemodialysis or peritoneal dialysis. J Hum Nutr Diet 2013;26:315-28.

K/DOQI:National Kidney Foundation. Clinical Practice Guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2000;35:1‐140.

Bovio G, Montagna G, Brazzo S, Piazza V, Segagni S, Cena H: Energy balance in haemodialysis and peritoneal dialysis patients assessed by a 7-day weighed food diary and a portable armband device. J Hum Nutr Diet 2013;26:276-85.

Honda H, Qureshi AR, Axelsson J, Heimburger O, Suliman ME, Barany P, Stenvinkel P, Lindholm B: Obese sarcopenia in patients with endstage renal disease is associated with inflammation and increased mortality. Am J Clin Nutr 2007;86:633-8.

Williams JD, Woods HF: Insulin resistance, the metabolic syndrome and renal failure - is there a special problem for patients treated with peritoneal dialysis?". Eur. Endocrine. Rev 2006;29:351-66.

Koc M, Toprak A, Tezcan H, Bihorac A, Akoglu E, Ozener IC: Uncontrolled hypertension due to volume overload contributes to higher left ventricular mass index in CAPD patients. Nephrol Dial Transplant 2002;17:1661-6,.

Su WS, Clase CM, Brimble KS, Margetts PJ, Wilkieson TJ, Gangji AS: Waist-to-Hip Ratio, Cardiovascular Outcomes, and Death in Peritoneal Dialysis Patients. Int J Nephrol 2010;5: 831243.

Axelsson J, Rashid Qureshi A, Suliman ME, Honda H, Pecoits-Filho R, Heimbürger O, Lindholm B, Cederholm T, Stenvinkel P: Truncal fat mass as a contributor to inflammation in end-stage renal disease. Am J Clin Nutr 2004;80:1222-9.

Morrison G: Metabolic effects of continuous ambulatory peritoneal dialysis. Annu Rev Med 1989;40: 163-72,

de Mutsert R, Grootendorst DC, Boeschoten EW, Brandts H, van Manen JG, Krediet RT, Dekker FW: Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients Am J Clin Nutr 2009;89:787-93.

Johansen KL, Young B, Kaysen GA, Chertow GM: Association of body size with outcomes among patients beginning dialysis. Am J Clin Nutr 2004;80:324-32.

Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB: Survival advantages of obesity in dialysis patients. Am J Clin Nutr 2005;81:543-54.

Grzegorzewska AE: The role of nutritional status in the outcome of peritoneal dialysis patients. Panminerva Med 2009;51:163-73.

Snyder JJ, Foley RN, Gilbertson DT, Vonesh EF, Collins AJ: Body size and outcomes on peritoneal dialysis in the United States. Kidney Int 2003;64:1838–44.

McDonald SP, Collins JF, Johnson DW: Obesity Is Associated with Worse Peritoneal Dialysis Outcomes in the Australia and New Zealand Patient Populations. J Am Soc Nephrol 2003;14:2894-901.

McDonald SP, Collins JF, Rumpsfeld M, Johnson DW: Obesity is a risk factor for peritonitis in the Australian and New Zealand peritoneal dialysis patient populations. Perit Dial Int 2004;24:340-6.


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