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MEETING ABSTRACTS
9 EVALUATION OF THE NUTRITIONAL STATUS ACCORDING TO ESSENTIAL AMINO ACID INTAKE IN HEMODIALYSIS PATIENTS Cheong Min Sohn, Su An Kim, Kim, Hye Jin. Dept. of Nutrition care service, Seoul National University of Bundang Hospital, Gumi-dong, Bundang-gu, Seongnam-Si, Gyeonggi-do, Korea 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. The recommended intakes are 1.2g/jg/day for protein, and 30~35 kca/kg/day for energy. However, most of the studies published food intake in diaysis patients is usually insufficient. Malnutrition can be caused by insufficient amino acid intake, increased energy expenditure, nutrient losses in dialysate, oxidant stress, metabolic acidosis 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±11.5y, men: 24, women: 27) by measuring anthropometric, biochemical parameters and food intakes by using 24hr recall methods. Dialysis adequacy (Kt/V) was 1.17±0.17 and urea reduction rate was 67.8±6.50. Subject's total energy intake and total protein intake were 1648.0±397.31kcal/day (28.8±5.82kcal/kg/day), 79.2±27.2g/day (1.38±0.41g/kg/day), respectively. The animal protein intake was 42.7±22.1g/day, essential amino acid intake was 23.4±9.92g/day, and the ratio of essential amino acids to total protein intake was 29.6±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.
10 SERUM PREALBUMIN IN THE DIALYSIS POPULATION Jen Strong, Les Spry, Alison Steiber, Teresa Gerbeling, Jackie Carder Dialysis Center of Lincoln, Inc. Lincoln, Nebraska, USA Serum prealbumin (prealb) has been used in dialysis patients (pts) as a marker of nutritional status. The K/DOQI Nutrition Guidelines recommend evaluating pts for protein-energy malnutrition (PEM) when prealb is < 30mg/dL. A longitudinal study of dialysis pts’ monthly lab data was conducted at a midwestern dialysis facility to evaluate differences in prealb between modality, ESRD etiology and albumin (alb) levels. Data sets were analyzed only if all of the following data were available: alb (bromocresol green), prealb (immunoturbidimetric), age, sex, modality and ESRD etiology. The final review consisted of 3601 data sets. % of data Mean Prealb mg/dL + SD ESRD Etiology Diabetes (DM) 49 25.0 + 8.5 Hypertension (HTN) 15.5 25.4 + 7.6 “Other” Etiology 37.7 27.7 + 9.5 Modality Home Hemodialysis (HH) 6.4 31.5 + 13.5 Peritoneal Dialysis (PD) 11.3 27.0 + 8.3 In-Center Hemodialysis (ICH) 82.3 25.5 + 8.3 Albumin Level g/dL <2.5 0.6 19.1+ 8.4 2.51-3.50 25.9 20.7+ 7.7 3.51-4.00 52 26.3+ 7.8 >4.01 21.4 32.0+ 8.6 The following description applies to the data sets analyzed: 49% were female; mean age 65+16 (SD) yrs; mean alb 3.76+0.4(SD); and mean prealb 26+8.8 (SD). Pts with DM and HTN as ESRD etiology had significantly lower prealb levels than did the category for “other” etiology (p<.05). The mean prealb was significantly different between modalities (p<.05) and albumin level (p<.001). An alb within normal range correlated with a prealb of 26.0. This data suggests that normal prealb levels for DM and HTN may be slightly lower than all other patients and less than the K/DOQI goal of >30mg/dL.
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11 THE RELATIONSHIP OF SERUM ALBUMIN TO SERUM PREALBUMIN IN THE DIALYSIS PATIENT Jen Strong, Les Spry, Alison Steiber, Teresa Gerbeling, Jackie Carder Dialysis Center of Lincoln, Inc. Lincoln, Nebraska, USA Serum albumin (alb) is widely used as a marker of nutritional status in the dialysis patient (pt) but it has been suggested that serum prealbumin (prealb) may be a more sensitive indicator. The K/DOQI Nutrition Guidelines recommend an alb > the lower limit of the normal range and a pt with a prealb < 30 mg/dL should be evaluated for protein-energy malnutrition (PEM). To determine the relationship between alb and prealb, a longitudinal study of dialysis pts’ monthly lab data was conducted at a midwestern dialysis facility. Data sets were analyzed only if all of the following data were available: alb, prealb, age, sex, modality and ESRD etiology. The final review consisted of 3601 data sets. The alb was measured using bromocresol green and prealb by immunoturbidimetric techniques. Alb levels were divided into 4 categories (see table). Alb Category < 2.50 2.51-3.50 3.51-4.00 > 4.01 Population % 0.6 25.9 52.0 21.4 Prealb mg/dL avg 19.1 20.7 26.3 32.0 95% CI 15.4-22.8 20.2-21.2 26.0-26.7 31.4-32.6 Total data sets 22 934 1873 771 The following description applies to the data sets analyzed: 49% were female; mean age 65+16 (SD) yrs; mean alb 3.76+0.4 (SD); mean prealb 26+8.8 (SD); 82.3% in-center hemodialysis, 11.3% peritoneal dialysis and 6.4% home hemodialysis. The alb and prealb were positively correlated and both were negatively correlated with age(p<.01). There was a significant difference in mean prealb between the alb categories (p<.001). The alb category was a stronger predictor of prealb level than was age, gender, modality or etiology (p<.001). Although K/DOQI recommends using a prealb of < 30 as an indicator of PEM, we found a prealb >26.0 to be associated with an alb level in the normal range for our current lab provider. Therefore in addition to an alb within the normal range, a prealb >26 is an indicator of adequate nutritional status. Clearly more research is needed to determine what range of prealb is associated with optimal pt outcomes.
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DIETARY PITFALL OF CHRISTMAS EVE AND NEW YEAR’S EVE ON WEEKENDS IN PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS. Kimiko Takahashi, Emi Kihara, Seiji Kawahara, Nanako Ikari, Kazuko Arita, Katsutoshi Maeda and Hiroaki Oda, Oda medical Clinic, Hiroshima, Japan. Both Christmas Eve and New Year’s Eve in 2005 were Saturdays and patients undergoing hemodialysis enjoyed their weekends eating special food and drink without dialysis therapy for two days. Increase in body weights and elevation of serum concentrations of urea nitrogen, creatitine (Cr), uric acids (UA) and phosphate (P) were predicted. The purpose of this study was to clarify the characteristics of food during these holiday seasons and the effects on the clinical features revealed by serum concentrations in hemodialysis patients. Eighty-four patients (male/female; 56/28, 61.6 years) for Christmas Eve and 74 patients (male/female; 44/30, 62.5 years) for New Year’s Eve were subjected to this study. Increase in body weights and serum concentrations of urea nitrogen, Cr, UA, P, potassium (K), sodium (Na), chloride (Cl), calcium (Ca), lipid profile and albumin (Alb) were measured just before and after the weekends of Christmas and the New year. Nutrition investigation was conducted in 16 patients with much increase in body weight during these weekends. Data were analyzed using paired t-test and p<0.05 were considered statistically significant. Significant increase in body weight during Christmas (+2.4 v.s. +2.2 kg) and the New Year (+2.6 v.s. +2.4 kg), and significant elevation of serum concentrations of urea nitrogen (69.8 v.s. 61.7 mg/dl, 75.3 v.s. 71.5 mg/dl), Cr (11.2 v.s. 10.4 mg/dl, 10.5 v.s. 10.2 mg/dl) and UA (7.5 v.s. 7.0 mg/dl, 7.8 v.s. 7.5 mg/dl) were found in comparison to those during usual weekends. Christmas food enriched in fat elevated serum concentrations of P (5.8 v.s. 5.3 mg/dl) and K (5.06 v.s. 4.95 mEq/l) significantly, although P and K intake were not increased. The New Year food was characterized by significant enrichment of NaCl (10.0 v.s. 7.7 g/day) and water (2,130 v.s. 1,650 ml/day), whereas calorie and fat were less compared to usual diet. Serum Na concentration (141 v.s. 139 mEq/l) was significantly elevated after the New Year. Japanese Christmas food generally consists of eggs, meat, fish, squid and shells. Increased intake of P and K resulted in the elevation of serum levels of urea nitrogen, Cr, UA, P and K. Special food for the New Year characterized by salt-rich ingredients subsequently followed by much water accumulation resulted in increase of body weight. Patients undergoing maintenance hemodialysis should pay attention to the diet during Christmas and the New Year, especially on weekends.
9 EVALUATION OF THE NUTRITIONAL STATUS ACCORDING TO ESSENTIAL AMINO ACID INTAKE IN HEMODIALYSIS PATIENTS Cheong Min Sohn, Su An Kim, Kim, Hye Jin. Dept. of Nutrition care service, Seoul National University of Bundang Hospital, Gumi-dong, Bundang-gu, Seongnam-Si, Gyeonggi-do, Korea 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. The recommended intakes are 1.2g/jg/day for protein, and 30~35 kca/kg/day for energy. However, most of the studies published food intake in diaysis patients is usually insufficient. Malnutrition can be caused by insufficient amino acid intake, increased energy expenditure, nutrient losses in dialysate, oxidant stress, metabolic acidosis 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±11.5y, men: 24, women: 27) by measuring anthropometric, biochemical parameters and food intakes by using 24hr recall methods. Dialysis adequacy (Kt/V) was 1.17±0.17 and urea reduction rate was 67.8±6.50. Subject's total energy intake and total protein intake were 1648.0±397.31kcal/day (28.8±5.82kcal/kg/day), 79.2±27.2g/day (1.38±0.41g/kg/day), respectively. The animal protein intake was 42.7±22.1g/day, essential amino acid intake was 23.4±9.92g/day, and the ratio of essential amino acids to total protein intake was 29.6±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.
10 SERUM PREALBUMIN IN THE DIALYSIS POPULATION Jen Strong, Les Spry, Alison Steiber, Teresa Gerbeling, Jackie Carder Dialysis Center of Lincoln, Inc. Lincoln, Nebraska, USA Serum prealbumin (prealb) has been used in dialysis patients (pts) as a marker of nutritional status. The K/DOQI Nutrition Guidelines recommend evaluating pts for protein-energy malnutrition (PEM) when prealb is < 30mg/dL. A longitudinal study of dialysis pts’ monthly lab data was conducted at a midwestern dialysis facility to evaluate differences in prealb between modality, ESRD etiology and albumin (alb) levels. Data sets were analyzed only if all of the following data were available: alb (bromocresol green), prealb (immunoturbidimetric), age, sex, modality and ESRD etiology. The final review consisted of 3601 data sets. % of data Mean Prealb mg/dL + SD ESRD Etiology Diabetes (DM) 49 25.0 + 8.5 Hypertension (HTN) 15.5 25.4 + 7.6 “Other” Etiology 37.7 27.7 + 9.5 Modality Home Hemodialysis (HH) 6.4 31.5 + 13.5 Peritoneal Dialysis (PD) 11.3 27.0 + 8.3 In-Center Hemodialysis (ICH) 82.3 25.5 + 8.3 Albumin Level g/dL <2.5 0.6 19.1+ 8.4 2.51-3.50 25.9 20.7+ 7.7 3.51-4.00 52 26.3+ 7.8 >4.01 21.4 32.0+ 8.6 The following description applies to the data sets analyzed: 49% were female; mean age 65+16 (SD) yrs; mean alb 3.76+0.4(SD); and mean prealb 26+8.8 (SD). Pts with DM and HTN as ESRD etiology had significantly lower prealb levels than did the category for “other” etiology (p<.05). The mean prealb was significantly different between modalities (p<.05) and albumin level (p<.001). An alb within normal range correlated with a prealb of 26.0. This data suggests that normal prealb levels for DM and HTN may be slightly lower than all other patients and less than the K/DOQI goal of >30mg/dL.
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11 THE RELATIONSHIP OF SERUM ALBUMIN TO SERUM PREALBUMIN IN THE DIALYSIS PATIENT Jen Strong, Les Spry, Alison Steiber, Teresa Gerbeling, Jackie Carder Dialysis Center of Lincoln, Inc. Lincoln, Nebraska, USA Serum albumin (alb) is widely used as a marker of nutritional status in the dialysis patient (pt) but it has been suggested that serum prealbumin (prealb) may be a more sensitive indicator. The K/DOQI Nutrition Guidelines recommend an alb > the lower limit of the normal range and a pt with a prealb < 30 mg/dL should be evaluated for protein-energy malnutrition (PEM). To determine the relationship between alb and prealb, a longitudinal study of dialysis pts’ monthly lab data was conducted at a midwestern dialysis facility. Data sets were analyzed only if all of the following data were available: alb, prealb, age, sex, modality and ESRD etiology. The final review consisted of 3601 data sets. The alb was measured using bromocresol green and prealb by immunoturbidimetric techniques. Alb levels were divided into 4 categories (see table). Alb Category < 2.50 2.51-3.50 3.51-4.00 > 4.01 Population % 0.6 25.9 52.0 21.4 Prealb mg/dL avg 19.1 20.7 26.3 32.0 95% CI 15.4-22.8 20.2-21.2 26.0-26.7 31.4-32.6 Total data sets 22 934 1873 771 The following description applies to the data sets analyzed: 49% were female; mean age 65+16 (SD) yrs; mean alb 3.76+0.4 (SD); mean prealb 26+8.8 (SD); 82.3% in-center hemodialysis, 11.3% peritoneal dialysis and 6.4% home hemodialysis. The alb and prealb were positively correlated and both were negatively correlated with age(p<.01). There was a significant difference in mean prealb between the alb categories (p<.001). The alb category was a stronger predictor of prealb level than was age, gender, modality or etiology (p<.001). Although K/DOQI recommends using a prealb of < 30 as an indicator of PEM, we found a prealb >26.0 to be associated with an alb level in the normal range for our current lab provider. Therefore in addition to an alb within the normal range, a prealb >26 is an indicator of adequate nutritional status. Clearly more research is needed to determine what range of prealb is associated with optimal pt outcomes.
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DIETARY PITFALL OF CHRISTMAS EVE AND NEW YEAR’S EVE ON WEEKENDS IN PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS. Kimiko Takahashi, Emi Kihara, Seiji Kawahara, Nanako Ikari, Kazuko Arita, Katsutoshi Maeda and Hiroaki Oda, Oda medical Clinic, Hiroshima, Japan. Both Christmas Eve and New Year’s Eve in 2005 were Saturdays and patients undergoing hemodialysis enjoyed their weekends eating special food and drink without dialysis therapy for two days. Increase in body weights and elevation of serum concentrations of urea nitrogen, creatitine (Cr), uric acids (UA) and phosphate (P) were predicted. The purpose of this study was to clarify the characteristics of food during these holiday seasons and the effects on the clinical features revealed by serum concentrations in hemodialysis patients. Eighty-four patients (male/female; 56/28, 61.6 years) for Christmas Eve and 74 patients (male/female; 44/30, 62.5 years) for New Year’s Eve were subjected to this study. Increase in body weights and serum concentrations of urea nitrogen, Cr, UA, P, potassium (K), sodium (Na), chloride (Cl), calcium (Ca), lipid profile and albumin (Alb) were measured just before and after the weekends of Christmas and the New year. Nutrition investigation was conducted in 16 patients with much increase in body weight during these weekends. Data were analyzed using paired t-test and p<0.05 were considered statistically significant. Significant increase in body weight during Christmas (+2.4 v.s. +2.2 kg) and the New Year (+2.6 v.s. +2.4 kg), and significant elevation of serum concentrations of urea nitrogen (69.8 v.s. 61.7 mg/dl, 75.3 v.s. 71.5 mg/dl), Cr (11.2 v.s. 10.4 mg/dl, 10.5 v.s. 10.2 mg/dl) and UA (7.5 v.s. 7.0 mg/dl, 7.8 v.s. 7.5 mg/dl) were found in comparison to those during usual weekends. Christmas food enriched in fat elevated serum concentrations of P (5.8 v.s. 5.3 mg/dl) and K (5.06 v.s. 4.95 mEq/l) significantly, although P and K intake were not increased. The New Year food was characterized by significant enrichment of NaCl (10.0 v.s. 7.7 g/day) and water (2,130 v.s. 1,650 ml/day), whereas calorie and fat were less compared to usual diet. Serum Na concentration (141 v.s. 139 mEq/l) was significantly elevated after the New Year. Japanese Christmas food generally consists of eggs, meat, fish, squid and shells. Increased intake of P and K resulted in the elevation of serum levels of urea nitrogen, Cr, UA, P and K. Special food for the New Year characterized by salt-rich ingredients subsequently followed by much water accumulation resulted in increase of body weight. Patients undergoing maintenance hemodialysis should pay attention to the diet during Christmas and the New Year, especially on weekends.