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Present Status and Perspectives in the Treatment of Malnutrition in Haemodialysis
Besides nutritional support, several therapeutic perspectives for the protein accretion of essential amino acid
27
and leucine
28
that have been
treatment of malnutrition in dialysis have emerged during the past 10 reported in elderly people need to be studied in a controlled fashion in
years. These perspectives include various treatments aiming to improve dialysis patients. Hence, the modulation of protein and amino acid
appetite, decrease protein breakdown and/or promote protein supply may be a way to counteract altered protein synthesis in
synthesis. Daily dialysis – known to induce a liberalisation of maintenance haemodialysis patients. Exercise and anabolic hormones
alimentation and an improvement of nutritional status – should be also appeared to be efficient ways of improving protein status. Pupim
assessed as a therapy for malnutrition in selected patients.
24
and co-workers showed that exercise combined with IDPN compared
Pentoxifylline, a tumour necrosis factor (TNF)-alpha antagonist, was with IDPN alone induced a two-fold increase in forearm muscle
reported to acutely decrease whole-body proteolysis in chronically essential amino acid uptake and net muscle protein accretion.
29
In a
controlled, randomised, double-blind study, the administration of
nandrolone decanoate was associated with an increase in muscle mass,
as assessed by pre-dialysis creatinine and dual energy X-ray
Data from FINES demonstrated
absorptiometry (DEXA), and an improvement of muscle performance.
30
Anabolic effects have been obtained in pilot studies with recombinant
that an increase in survival and an
growth hormone and insulin-like growth factor-1 in adult dialysis
improvement in morbidity can be patients.
31
Prolonged nutritional studies are required to establish the
expected when an amelioration
beneficial effect and the tolerance of these therapies.
of nutritional status is obtained
Therefore, present data demonstrate that in malnourished
during nutritional support.
haemodialysis patients nutritional support is able to improve
nutritional status. Moreover, data from FINES demonstrated that
an increase in survival and an improvement in morbidity can
be expected when an amelioration of nutritional status is obtained
uraemic patients.
25
Because of the implication of inflammation in during nutritional support. Besides nutritional supplementation,
protein catabolism, such an anti-inflammatory approach to protein numerous therapeutic perspectives need to be investigated during
depletion may be an interesting subject of clinical research on malnutrition in dialysis. Among them, the combination of nutritional
malnourished dialysis patients. Protein synthesis was reported to be support, exercise and anabolic agents has been reported to improve
improved by modulations of protein delivery in terms of either timing nutritional status and survival in other chronic diseases, such as
or composition of protein supply.
26
In elderly patients on haemodialysis, chronic obstructive pulmonary disease.
32
Such a multidisciplinary
branched-chain amino acid supplements have been shown to improve approach to the treatment of malnutrition should be evaluated in
both nutrient intakes and nutritional status.
14
Similarly, the effects on haemodialysis patients. ■
1. Owen WF Jr, Lew NL, Liu Y, et al., The urea reduction ratio and patients, Am J Clin Nutr, 1990;51:558–62. 22. Toigo G, Aparicio M, Attman PO, et al., Expert Working Group
serum albumin concentration as predictors of mortality in 12. Tietze IN, Pedersen EB, Effect of fish protein supplementation report on nutrition in adult patients with renal insufficiency
patients undergoing hemodialysis, N Engl J Med, 1993;329: on aminoacid profile and nutritional status in haemodialysis (part 1 of 2), Clin Nutr, 2000;19:197–207.
1001–6. patients, Nephrol Dial Transplant, 1991;6:948–54. 23. Cano N, Fiaccadori E, Tesinsky P, et al., ESPEN Guidelines on
2. Combe C, Chauveau P, Laville M, et al., Influence of nutritional 13. Eustace JA, Coresh J, Kutchey C, et al., Randomized double- Enteral Nutrition: Adult renal failure, Clin Nutr, 2006;25:
factors and haemodialysis adequacy on the survival of 1,610 blind trial of oral essential amino acids for dialysis-associated 295–310.
French patients, Am J Kidney Dis, 2001;37:S81–S88. hypoalbuminemia, Kidney Int, 2000;57:2527–38. 24. Galland R, Traeger J, Arkouche W, et al., Short daily
3. Kalantar-Zadeh K, Block G, McAllister CJ, et al., Appetite 14. Hiroshige K, Sonta T, Suda T, et al., Oral supplementation of haemodialysis rapidly improves nutritional status in
and inflammation, nutrition, anemia, and clinical outcome branched-chain amino acid improves nutritional status in elderly haemodialysis patients, Kidney Int, 2001;60:1555–60.
in haemodialysis patients, Am J Clin Nutr, 2004;80: patients on chronic haemodialysis, Nephrol Dial Transplant, 25. Biolo G, Ciocchi B, Bosutti A, et al., Pentoxifylline acutely
299–307. 2001;16:1856–62. reduces protein catabolism in chronically uremic patients, Am J
4. National Kidney Foundation, Kidney Disease Outcomes Quality 15. Sharma M, Rao M, Jacob S, Jacob CK, A controlled trial of Kidney Dis, 2002;40:1162–72.
Initiative. Clinical Practice Guidelines for Nutrition in Chronic intermittent enteral nutrient supplementation in maintenance 26. Walrand S, Boirie Y, Optimizing protein intake in aging, Curr
Renal Failure. I. Adult guidelines. A. Maintenance dialysis, Am J haemodialysis patients, J Ren Nutr, 2002;12:229–37. Opin Clin Nutr Metab Care, 2005;8:89–94.
Kidney Dis, 2000;35(Suppl. 2):S17–S55. 16. Guarnieri G, Faccini L, Lipartiti T, et al., Simple methods for 27. Volpi E, Kobayashi H, Sheffield-Moore M, et al., Essential amino
5. Toigo G, Aparicio M, Attman PO, et al., Expert working group nutritional assessment in hemodialyzed patients, Am J Clin Nutr, acids are primarily responsible for the amino acid stimulation of
report on nutrition in adult patients with renal insufficiency 1980;33:1598–1607. muscle protein anabolism in healthy elderly adults, Am J Clin
(Part 2 of 2), Clin Nutr, 2000;19:281–91. 17. Wolfson M, Jones MR, Kopple JD, Amino acid losses during Nutr, 2003;78:250–58.
6. Fouque D, Vennegoor M, Ter Wee Pea, EBPG guideline in haemodialysis with infusion of amino acids and glucose, Kidney 28. Rieu I, Balage M, Sornet C, et al., Leucine supplementation
nutrition, Nephrol Dial Transplant, 2007;22:ii45–ii87. Int, 1982;21:500–6. improves muscle protein synthesis in elderly men independently
7. Veeneman JM, Kingma HA, Boer TS, et al., Protein intake 18. Cano N, Labastie-Coeyrehourcq J, Lacombe P, et al., Perdialytic of hyperaminoacidaemia, J Physiol, 2006;575:305–15.
during haemodialysis maintains a positive whole body protein parenteral nutrition with lipids and amino-acids in malnourished 29. Pupim LB, Flakoll PJ, Levenhagen DK, Ikizler TA, Exercise
balance in chronic haemodialysis patients, Am J Physiol haemodialysis patients, Am J Clin Nutr, 1990;52:726–30. augments the acute anabolic effects of intradialytic parenteral
Endocrinol Metab, 2003;284:E954–65. 19. Navarro JF, Mora C, Leon C, et al., Amino acid losses during nutrition in chronic haemodialysis patients, Am J Physiol
8. Pupim LB, Flakoll PJ, Brouillette JR, et al., Intradialytic haemodialysis with polyacrylonitrile membranes: effect of Endocrinol Metab, 2004;286:E589–97.
parenteral nutrition improves protein and energy homeostasis in intradialytic amino acid supplementation on plasma amino acid 30. Johansen KL, Mulligan K, Schambelan M, Anabolic effects of
chronic haemodialysis patients, J Clin Invest, 2002;110:483–92. concentrations and nutritional variables in nondiabetic patients, nandrolone decanoate in patients receiving dialysis: a
9. Leon JB, Majerle AD, Soinski JA, et al., Can a nutrition Am J Clin Nutr, 2000;71:765–73. randomized controlled trial, JAMA, 1999;281:1275–81.
intervention improve albumin levels among haemodialysis 20. Cano N, Fouque D, Roth H, et al., Intradialytic parenteral 31. Fouque D, Guebre-Egziabher F, Laville M, Advances in anabolic
patients? A pilot study, J Ren Nutr, 2001;11:9–15. nutrition in malnourished haemodialysis patients: a two-year interventions for malnourished dialysis patients, J Ren Nutr,
10. Acchiardo S, Moore L, Cockrell S, Effect of essential amino multicenter prospective randomized study, J Am Soc Nephrol, 2003;13:161–5.
acids (EAA) on chronic haemodialysis (CHD) patients (PTS), 2007; in press. 32. Schols AMWJ, Slangen J, Volovics L, Wouters EFM, Weight
Trans Am Soc Artif Intern Organs, 1982;28:608–14. 21. Cano NJ, Roth H, Aparicio M, et al., Malnutrition in loss is a reversible factor in the prognosis of chronic
11. Allman MA, Stewart PM, Tiller DJ, et al., Energy haemodialysis diabetic patients: evaluation and prognostic obstructive pulmonary disease, Am J Respir Crit Care Med,
supplementation and the nutritional status of haemodialysis influence, Kidney Int, 2002;62:593–601. 1998;157:1791–7.
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