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PP085 ENTERAL NUTRITION AND SURVIVAL IN AMYOTROPHIC LATERAL SCLEROSIS
56
Poster presentations
energy intakes are to be corrected. Taste abnormalities, unknown in ALS can favour malnutrition and need to be explored.
PP086 MALNUTRITION PREDICTS CRITICAL SKIN PERFUSION DURING HEMODIALYSIS (HD)
Disclosure of Interest: None declared
E. Mistrik1 , S. Dusilova-Sulkova1 , R. Safranek1 , V. Blaha1 , L. Sobotka1 . 1 Department of gerontology and metabolism, University Hospital and Medical Faculty, Hradec Kralove, Czech Republic
PP085 ENTERAL NUTRITION AND SURVIVAL IN AMYOTROPHIC LATERAL SCLEROSIS M. Muscaritoli1 , I. Kushta2 , S. Lucci1 , A. Molfino2 , V. Tommasi2 , M. Sabatelli3 , F. Rossi Fanelli1 . 1 Department of Clinical Medicine, Sapienza University of Rome, 2 Department of Clinical Medicine, Sapienza University of Rome, 3 Departament of Neurology, Catholic University, Rome, Italy Rationale: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease characterized by progressive muscle atrophy. Five-year survival ranges 18 40%. Home enteral nutrition (HEN) through percutaneous endoscopic gastrostomy (PEG) is indicated to prevent ingestion pneumonia, dehydration and protein energy malnutrition. Aim was togain insights into the implementation of HEN protocols for the prevention and treatment of malnutrition in ALS. Methods: We retrospectively analysed the clinical records of 120 ALS patients (56 M, 64 F) referred to our Clinical Nutrition Unit from 2002 to 2009 to initiate HEN. Results: Out of the 120 patients, 78 (34 M, 44 F) died and 42 (22M and 20F) are currently on HEN. Mean time between ALS diagnosis and PEG placement was 635±541 days (median 539.9 days). In the group of 78 patients who died, mean HEN duration was 218±214 days. Moreover, time interval between ALS diagnosis and PEG placement was related to survival. In fact, patients in whom PEG was placed within 1 year after diagnosis (n = 27) survived 593±259 days (median 534 days), while patients in whom PEG was placed 1 year after ALS diagnosis (n = 51) survived 1056±591 days (median 890 days), respectively (p < 0.001). The proportion of bulbar onset ALS was higher in the first group. Nutritional status was maintained in both groups. Conclusion: Patients with rapidly progressive disease (e.g. bulbar onset ALS) develop indication for PEG placement earlier and die earlier, despite appropriate nutritional intervention. Novel nutritional and metabolic strategies are needed to modify the progression of the disease. References [1] Desport JC, Preux PN, Truong TC, Vallat JM, Sautereau D, Couratier P. Nutritional status is a prognostic factor for survival in ALS patients. Neurology 1999; 53: 1059 63. [2] Desport JC, Torny F, Lacoste M, Preux PM, and Couratier P. Hypermetabolism in ALS: correlations with clinical and paraclinical parameters. Neurodegenerativ Dis 2005; 2: 202 207.
Rationale: Malnutrition associated with non-healing wounds is frequent problem in patients on chronic HD. The aim of present study was to estimate the influence of malnutrition on skin perfusion during HD. Methods: Peripheral skin perfusion was measured using Laser Doppler Line Scanner (LDLS® , Moor, Devon, UK) in 10 different areas (AI) of dorsal part of instep and toes of each foot before and 30, 90, 210 minutes after the start of HD with ultrafiltration (897±465 mL) in 40 patients (19 female, 21 male; age 36 79 y, BMI= 28±5.0). Body composition was assessed by multifrequency bioimpedance analysis (BCM, Fresenius, Bad Homburg, Germany). Two-sample t-test, Spearman correlation and Kaplan Meier analysis were used for statistical analysis. Results: See the table. Table Instep
rel LTM (%) rel Fat (%)
Before HD
30 min
r
p
r
p
r
90 min p
r
210 min p
After end HD r
p
0.41 0.39
0.01 0.01
0.41 0.39
<0.01 0.02
0.53 0.55
<0.01 <0.01
0.33 0.39
0.04 0.01
0.3 0.35
0.06 0.03
Rel LTM: relative lean tissue mass.
Significant and constant decrease of skin blood flow during HD was found (p < 0.001). Skin perfusion on instep before and during HD correlated with body composition parameters (see table) and with serum albumin (r = 0.47; p = 0.007). If patients were divided according to presence of critical perfusion, group with critical perfusion had more fat mass (40±11 kg vs. 30±9 kg; p = 0.003) than group with normal perfusion. Patients with critical perfusion develop significantly more ischemic skin defects (62% vs. 7%, p = 0.002, Kaplan Meier analysis). Conclusion: Presence of lean tissue mass protects from critical skin perfusion. Presence of critical skin perfusion leads to development of ischemic skin defects. Supported by research grants: IGA MH CR No. NR/9743 4, MSM 0021620820 Disclosure of Interest: None declared
PP087 Outstanding abstract EFFECTS OF SERUM PHOSPHORUS WITHIN NORMAL RANGE ON CORONARY CALCIFICATION IN KOREANS WITH NORMAL RENAL FUNCTION K.S. Park1 , J.W. Jang1 , W.S. Yang1 , S.B. Kim1 , S.K. Park1 , S.K. Lee1 , J.S. Park1 . 1 Internal Medicine, Nephrology, Asan Medical Center, Seoul, Korea, Republic Of
Disclosure of Interest: None declared
Rationale: Higher levels of serum phosphorus are associated with the increased risk of cardiovascular disease (CVD) and mortality in patients with chronic kidney disease (CKD). Although this relationship was also reported in Western individuals without CKD, it is unknown whether this correlation is present in Koreans
Poster presentations
energy intakes are to be corrected. Taste abnormalities, unknown in ALS can favour malnutrition and need to be explored.
PP086 MALNUTRITION PREDICTS CRITICAL SKIN PERFUSION DURING HEMODIALYSIS (HD)
Disclosure of Interest: None declared
E. Mistrik1 , S. Dusilova-Sulkova1 , R. Safranek1 , V. Blaha1 , L. Sobotka1 . 1 Department of gerontology and metabolism, University Hospital and Medical Faculty, Hradec Kralove, Czech Republic
PP085 ENTERAL NUTRITION AND SURVIVAL IN AMYOTROPHIC LATERAL SCLEROSIS M. Muscaritoli1 , I. Kushta2 , S. Lucci1 , A. Molfino2 , V. Tommasi2 , M. Sabatelli3 , F. Rossi Fanelli1 . 1 Department of Clinical Medicine, Sapienza University of Rome, 2 Department of Clinical Medicine, Sapienza University of Rome, 3 Departament of Neurology, Catholic University, Rome, Italy Rationale: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease characterized by progressive muscle atrophy. Five-year survival ranges 18 40%. Home enteral nutrition (HEN) through percutaneous endoscopic gastrostomy (PEG) is indicated to prevent ingestion pneumonia, dehydration and protein energy malnutrition. Aim was togain insights into the implementation of HEN protocols for the prevention and treatment of malnutrition in ALS. Methods: We retrospectively analysed the clinical records of 120 ALS patients (56 M, 64 F) referred to our Clinical Nutrition Unit from 2002 to 2009 to initiate HEN. Results: Out of the 120 patients, 78 (34 M, 44 F) died and 42 (22M and 20F) are currently on HEN. Mean time between ALS diagnosis and PEG placement was 635±541 days (median 539.9 days). In the group of 78 patients who died, mean HEN duration was 218±214 days. Moreover, time interval between ALS diagnosis and PEG placement was related to survival. In fact, patients in whom PEG was placed within 1 year after diagnosis (n = 27) survived 593±259 days (median 534 days), while patients in whom PEG was placed 1 year after ALS diagnosis (n = 51) survived 1056±591 days (median 890 days), respectively (p < 0.001). The proportion of bulbar onset ALS was higher in the first group. Nutritional status was maintained in both groups. Conclusion: Patients with rapidly progressive disease (e.g. bulbar onset ALS) develop indication for PEG placement earlier and die earlier, despite appropriate nutritional intervention. Novel nutritional and metabolic strategies are needed to modify the progression of the disease. References [1] Desport JC, Preux PN, Truong TC, Vallat JM, Sautereau D, Couratier P. Nutritional status is a prognostic factor for survival in ALS patients. Neurology 1999; 53: 1059 63. [2] Desport JC, Torny F, Lacoste M, Preux PM, and Couratier P. Hypermetabolism in ALS: correlations with clinical and paraclinical parameters. Neurodegenerativ Dis 2005; 2: 202 207.
Rationale: Malnutrition associated with non-healing wounds is frequent problem in patients on chronic HD. The aim of present study was to estimate the influence of malnutrition on skin perfusion during HD. Methods: Peripheral skin perfusion was measured using Laser Doppler Line Scanner (LDLS® , Moor, Devon, UK) in 10 different areas (AI) of dorsal part of instep and toes of each foot before and 30, 90, 210 minutes after the start of HD with ultrafiltration (897±465 mL) in 40 patients (19 female, 21 male; age 36 79 y, BMI= 28±5.0). Body composition was assessed by multifrequency bioimpedance analysis (BCM, Fresenius, Bad Homburg, Germany). Two-sample t-test, Spearman correlation and Kaplan Meier analysis were used for statistical analysis. Results: See the table. Table Instep
rel LTM (%) rel Fat (%)
Before HD
30 min
r
p
r
p
r
90 min p
r
210 min p
After end HD r
p
0.41 0.39
0.01 0.01
0.41 0.39
<0.01 0.02
0.53 0.55
<0.01 <0.01
0.33 0.39
0.04 0.01
0.3 0.35
0.06 0.03
Rel LTM: relative lean tissue mass.
Significant and constant decrease of skin blood flow during HD was found (p < 0.001). Skin perfusion on instep before and during HD correlated with body composition parameters (see table) and with serum albumin (r = 0.47; p = 0.007). If patients were divided according to presence of critical perfusion, group with critical perfusion had more fat mass (40±11 kg vs. 30±9 kg; p = 0.003) than group with normal perfusion. Patients with critical perfusion develop significantly more ischemic skin defects (62% vs. 7%, p = 0.002, Kaplan Meier analysis). Conclusion: Presence of lean tissue mass protects from critical skin perfusion. Presence of critical skin perfusion leads to development of ischemic skin defects. Supported by research grants: IGA MH CR No. NR/9743 4, MSM 0021620820 Disclosure of Interest: None declared
PP087 Outstanding abstract EFFECTS OF SERUM PHOSPHORUS WITHIN NORMAL RANGE ON CORONARY CALCIFICATION IN KOREANS WITH NORMAL RENAL FUNCTION K.S. Park1 , J.W. Jang1 , W.S. Yang1 , S.B. Kim1 , S.K. Park1 , S.K. Lee1 , J.S. Park1 . 1 Internal Medicine, Nephrology, Asan Medical Center, Seoul, Korea, Republic Of
Disclosure of Interest: None declared
Rationale: Higher levels of serum phosphorus are associated with the increased risk of cardiovascular disease (CVD) and mortality in patients with chronic kidney disease (CKD). Although this relationship was also reported in Western individuals without CKD, it is unknown whether this correlation is present in Koreans