Association of the Nutritional Status and Essential Amino Acids Intake in Hemodialysis Patients

혈액투석환자에서 영양상태와 필수아미노산 섭취의 관련성 연구

  • Kim, Hye-Jin (Department of Nutrition Care Service, Seoul National University of Bundang Hospital) ;
  • Kim, Su-An (Department of Nutrition Care Service, Seoul National University of Bundang Hospital) ;
  • Sohn, Cheong-Min (Department of Nutrition Care Service, Seoul National University of Bundang Hospital)
  • 김혜진 (분당서울대학교병원 영양실) ;
  • 김수안 (분당서울대학교병원 영양실) ;
  • 손정민 (분당서울대학교병원 영양실)
  • Published : 2006.10.31

Abstract

The mortality and morbidity rate of hemodialysis patients (HD) remain high. Among many factors, protein and calorie malnutrition has been shown to be a major risk factor for increased mortality in the HD patients population. Malnutrition can be caused by insufficient amino acid intake, nutrient losses in dialysate, oxidant stress and muscle catabolism. In this study, we evaluated the association of markers of nutritional status and essential amino acids intake in HD patients. We investigated nutritional status of 41 HD patients (mean age: $64.2\;{\pm}\;11.5\;y$, men: 24, women: 27) by measuring anthropometric, biochemical parameters and food intakes by using 24 hr recall methods. Subject's total energy intake and total protein intake were $1,648.0\;{\pm}\;397.31\;kcal/day,\;79.2\;{\pm}\;27.2\;g/day$:, respectively. The animal protein intake was $42.7\;{\pm}\;22.1\;g/day$, essential amino acids intake was $23.4\;{\pm}\;9.92\;g/day$, and the ratio of essential amino acids to total protein intake was $29.6\;{\pm}\;5.42%$. There were significantly positive correlation between muscle mass and lean body mass with serum creatinine level (r=0.435, p<0.01; r=0.435, p<0,01). There were also significant positive correlation in muscle mass and lean body mass with pre hemodialysis blood urea nitrogen (preHD BUN) (r=0.329, p<0.05; r=0.329, p<0.05). There were no significant correlation in total energy intake and total protein intake per kg ideal body weight (IBW) to muscle mass and lean body mass. However, there were significantly positive correlation between the ratio of essential amino acids and muscle mass and lean body mass (r=0.368, p<0.05; r=0.405, p<0.01). And serum hematocrit concentration was positively correlated with the ratio of essential amino acids (r=0.032, p<0.05). The results of this study indicate that strong associations exist in essential amino acid intakes with malnutrition than total protein intakes in HD patient. In conclusion, specialized nutrition education should be necessary to efficiently improve the quality of protein intakes.

Keywords

References

  1. Bergstrom J, Lindholm B. Nutrition and adequacy of dialysis: How do hemodialysis and CADP compare? Kidney Int 43(40): S39-50, 1993
  2. National Kidney Foundation. K/DOQI, Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 35 (6): S1-140, 2000 https://doi.org/10.1016/S0272-6386(00)70294-0
  3. Locatelli F, Fouque D, Heimburger O, Drueke TB, Cannata- Andia JB, Horl WH, Riz E. Nutritional status in dialysis patients: A European consensus. Nephrol Dial Transplant 17(4): 563-572, 2002 https://doi.org/10.1093/ndt/17.4.563
  4. Burrowes JD, Cockram DB, Dwyer JT, Larive B, Paranandi L, Bergen C, Poole D. Cross-sectional relationship between dietary protein and energy intake, nutritional status, functional status, and comorbidity in older versus younger hemodialysis patients. Ren Nutr 12(2): 87-95, 2002 https://doi.org/10.1053/jren.2002.32209
  5. Kopple JD. Therapeutic approaches to malnutrition in chronic dialysis patients: The different modalities of nutritional support. Am J Kidney Dis 33: 180-185, 1995 https://doi.org/10.1016/S0272-6386(99)70280-5
  6. Mohrotra R, Kopple JD. Nutritional management of maintenance dialysis patients: Why aren't we doing better? Annu Rev Nutr 21: 343-379, 2001 https://doi.org/10.1146/annurev.nutr.21.1.343
  7. Acchiardo SR, Moore LW, Latour PA. Malnutrition as the main factor in morbidity and mortality of hemodialysis patients. Kidney Int 24: S199-203, 1983
  8. Parker TF, Laird NM, Lowire EG. Comparison of the study groups in the national cooperative dialysis study and a description of morbidity, mortality and patient withdrawal. Kidney Int 23(S13): S42-49, 1983
  9. Bergstrom J. Why are dialysis patients malnourished? Am J Kidney Dis 26: 229-241, 1995 https://doi.org/10.1016/0272-6386(95)90178-7
  10. Kwak IS. Nutritions of hemodialysis patients. Korean J Nephrol 16(2): S170-183, 1997
  11. Thunberg BJ, Swamy AP, Cestero RVM. Cross-sectional and longitudinal nutritional measurements in maintenance hemodialysis patients. Am J Clin Nutr 34: 2005-2012, 1981 https://doi.org/10.1093/ajcn/34.10.2005
  12. Chang YK, Jin YG , Park HC. Dietary evaluation and protein catabolic rate in maintenance hemodialysis patients. Korea J Nutrition 25(3): 256-263, 1992
  13. Junko K, Yoshio S, Nobuhiro S. Evaluation of amino acid pattern in recipes for kidney disease patients. J Renal Nutr 13(2): 126-132, 2003 https://doi.org/10.1053/jren.2003.50010
  14. Daugirdas JT. Second generation logarithmic estimates of single pool variable volume Kt/V: an analysis of error. J Am Nephrol 4(5): 1205-1213
  15. Daugirdas JT, Blake PG, Ing TS. Handbook of Dialysis. 3rd Ed. Lipplingott Willams & Winlkins, Philadelphia, 2001
  16. Ikizer TA. Protein and energy: Recommended intake and nutrient supplementation in chronic dialysis patients. Semin Dial 17(6): 471-478, 2004 https://doi.org/10.1111/j.0894-0959.2004.17608.x
  17. Lowrie EG, Lew NL. Death risk in hemodialysis patients: The predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 15: 458-482, 1990 https://doi.org/10.1016/S0272-6386(12)70364-5
  18. United State Renal Data System. USRDS 1997 Annual Data Report, 1997
  19. Shetty PS, Watrasiewicz KE, Jung RT, James WPT. Rapid-turnover transport proteins: an index of subclinical protein-energy malnutrition. Lancet 2: 230-232, 1979
  20. Collins JP, Mccarthy ID, Hill GL. Assessment of protein nutrition in surgical patients the value of anthropometrics. Am J Clin Nutr 32: 1527-1530, 1979 https://doi.org/10.1093/ajcn/32.7.1527
  21. Yoo HS, Wu HJ, Kang ET, Cho YY. Evaluation of nutritional status and changes of biochemical parameters according to protein intake levels in hemodialysis patients. Korean J Nephrol 19 (5): 769-777, 2000
  22. Wolfson M. Management of protein and energy intake in dialysis patients. J Am Soc Nephrol 10: 2244-2247, 1999
  23. Marcus RG, Cohl E, Uribarri J. Protein intake seems to respond to increases in Kt/V despite baseline Kt/V greater than 1.2. Am J Nephrol 19: 500-504, 1999 https://doi.org/10.1159/000013417
  24. Yeun JY, Kaysen GA. Acute phase proteins and peritoneal dialysate albumin loss are the main determinants of serum albumin in peritoneal dialysis patients. Am J Kidney Dis 30: 923-927, 1997 https://doi.org/10.1016/S0272-6386(97)90105-0
  25. Combe C, McCullough KP, Asano Y, Ginsberg N, Maroni BJ, Pifer TB. Kidney Disease Outcomes Quality Initiative (K/DOQI) and the Dialysis Outcomes and Practice Patterns Study (DOPPS): Nutrition guidelines, indicators, and practices. Am J Kidney Dis 44(S2): S39-46, 2004
  26. Kim MS, Ko KS, Park WD. Assessment of parameters between diabetic and non-diabetic patients undergoing maintenance hemodialysis. Korean J Intern Med 51(4): 472-479, 1996
  27. Nakao T, Matsumoto H, Okada T, Kanazawa Y, Yoshino M, Nagaoka Y, Takeguchi F. Nutritional management of dialysis patients: balancing among nutritional intake, dialysis dose, and nutritional status. Am J Kindey Dis 41(S1): S133-136, 2003
  28. Kim SH, Kim SB. Characteristics in nutritional status of patients on hemodialysis and continuous ambulatory peritoneal patients in Chonbuk Area. Korea J Nutrition 36(4): 397-404, 2003
  29. Hiroshige K, Sonta T, Suda T, Kanegae K, Ohtani A. Oral supplementation of branched-chain amino acid improves nutritional status in elderly patients on chronic hemodialysis. Nephrol Dial Transplant 16: 1856-1862, 2001 https://doi.org/10.1093/ndt/16.9.1856
  30. Kim YH, Seo HJ, Kim SR. A study of nutritional status, nutritional knowledge, and dietary habits of the hemodialysis patients. Korea J Nutrition 34(8): 920-928, 2001
  31. Kim HY, Kim B, Lee YH, Huh WS, Kim YG, Kim DJ, Oh HY, Yom JI, Park KL, Cho YY. Dietary protein intake and nutritional indices in predialysis patients with different stage of chronic renal insufficiency. Korean J Nephrol 17(3): 429-439, 1998
  32. Leon JB, Albert JM, Gilchrist G, Kushner I, Lerner E, Mach S, Majerle A, Porter D, Ricanati E, Sperry L, Sullivan C, Zimmerer J, Sehgal AR. Improving albumin levels among hemodialysis patients: a community-based randomized controlled trial. Am J Kidney Dis Jul 48(1): 28-36. 2006 https://doi.org/10.1053/j.ajkd.2006.03.046
  33. Giaramazidou T, Giovreki A, Morfakidou L, Iliou C, Karapanagiotou P. A study of dietary knowledge and its religious relationship in patients receiving haemodialysis. EDTNA ERCA J Oct-Dec 31(4): 199-202. 2005 https://doi.org/10.1111/j.1755-6686.2005.tb00429.x