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S 29 Plenary session
S 29 Nutrition
Grosser Saal, 29th September 2015, 8:30 – 10:00
Programme of the Session:
GS: Wilfred Druml (Austria)
Intradialytic Nutrition in chronic hemodialysis patients
O 88
A new approach for the improvement of nutritional parameters in CKD patients
Ana Lino (Portugal)
O 89
Relationship between anthropometric parameters and mini nutritional assessment
Mukadder Mollaoglu (Turkey)
O 90
Can an intradialytic exercise programme improve the nutritional status of CKD patients?
Rui Camisa (Portugal)
Abstracts:
GUEST SPEAKER
Intradialytic Nutrition in chronic hemodialysis patients
W. Druml1
1Department of Nephrology, Vienna General Hospital, Vienna, Austria
Background: Patients on chronic hemodialysis therapy are at a high risk of developing malnutrition, due to a reduction of spontaneous nutrient intake, to disease related alterations of metabolism and therapy associated nutrient losses.
Objectives:Intradialytic nutrition for several decades was deemed not advisable because of the fear that it might exacerbate hemodynamic derangements of hemodialysis. Recently, intradialytic period has become a preferred target for nutritional interventions following a stepwise approach:
Methods: Oral nutrition nowadays is recommend in most dialysis units worldwide. In several institutions special programs have been developed offering attractive meals.
I patients who cannot enhance nutrient intake by eating provision of oral nutritional supplements (ONS) should be tried (intradialytic enteral nutrition – IDEN). Several studies have documented the efficacy of IDEN .
If patients are unwilling or unable to increase nutrient intake by the oral/ enteral route, intradialytic parenteral nutrition (IDPN) should be offered.
Nowadays, complete nutritional admixtures are used, containing amino acids, glucose and lipid emulsions. Other nutrients such as vitamins, carnitine or also insulin can be added to the nutrition solution.
Results: A large number of studies on IPDN, often uncontrolled have documented an improvement in various markers of nutritional state. In the only large multicenter randomized controlled study overall mortality was not improved; however, in patients responding to the nutrition intervention (increase in prealbumin) there was also an improvement in survival.
Conclusion/Application to practice: Taken together, the intradialytic period ha become an attractive time interval where several intervnetions can be employed to improve the nutritional state of hemodialysis patients.
Disclosure: lecture fees from various nutrition companies, such as Fresenius Kabi, Baxter or BBraun
BIOGRAPHY OF THE GUEST SPEAKER
O 88
A new approach for the improvement of nutritional parameters in CKD patients
A. Lino1, H. Araújo1, A. Bernardo1, A. Valente1, J. Fazendeiro Matos2, M.T. Parisotto3
1NephroCare Covilhã, Fresenius Medical Care, Covilhã, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Porto, Portugal; 3NephroCare Coordination, Fresenius Medical Care, Bad Homburg, Germany
Background: Malnutrition is a major problem in chronic haemodialysis patients, a complication that appears to be an independent predictor of mortality.
Objectives: Define and implement a systematic diagnosis and intervention programme to improve the nutritional parameters of haemodialysis patients.
Methods: In May 2014, we implemented a systematic diagnoses and intervention programme and assessed the nutritional status of 104 haemodialysis patients by means of various parameters: Nutrient intake, nutritional score, laboratory values, body composition by spectroscopy.
Patients with a lean tissue index (LTI) below target and/or albumin <3.9 g/dL and/or nPCR <1.2g/kg/day were assigned to nutritional consultations and systematic follow-up.
Results:
In May 2014:
- 42.1% of patients had albumin levels ≥4 g/dL;
- 11.5% of patients had phosphorus levels ≤3.4 mg/dL and 43.2% between ≥3.5 and ≤3.9 mg/dL; 45.3% had values of ≥4 g/dL;
- 55% of our patients were below the LTI target range.
In November 2014:
- Albumin values had an increase of more than 25%;
- 59.6% of patients had albumin levels ≥4 g/dL;
- 5.7% of patients had phosphorus levels ≤3.4 mg/dL; 34.6% between ≥3.5 and ≤3.9 mg/dL and 59.6% had values of ≥4 g/dL;
- 24% of our patients were below the LTI target range.
Conclusion/Application to practice: After implementation of a nutritional programme the percentage of patients reaching the LTI and albumin targets has increased. Regular assessment of the nutritional status in dialysis patients should be a routine measure to recognise potential malnutrition risks at an early stage and take systematic multidimensional measures.
Disclosure: No conflict of interest declared
O 89
Relationship between anthropometric parameters and mini nutritional assessment
M. Mollaoglu1, M. Kayataş2, F. Candan2, B. Yürügen3
1Health Sciences Faculty, Cumhuriyet University, Sivas, Turkey; 2Nephrology (MD), Cumhuriyet University, Sivas, Turkey; 3Nursing School, Okan University, İstanbul, Turkey
Background: Malnutrition is common in patients with end-stage renal disease requiring dialysis treatment. Anthropometric parameters are reliable and valid measurements that indicate nutritional status in hemodialysis patients (HD).
Objectives: This study was carried out to describe the relationship between antropometric parameters and nutritional status in dialysis patients.
Methods: In a cross sectional, descriptive study, the data were obtained from 320 patients of all the hemodialysis centers in Sivas. Data were collected by using a personal data form, the Mini Nutritional Assessment (MNA) scale and the List of Anthropometric Paramaters (LAP).
Results: 112 (51.4%) patients out of 218 participants were men and their mean age was 54.3±13.1 years (range, 18–83). The mean duration of HD was 58,65±34,98 months. A significant correlation was found between the MNA score and the anthropometric measurements: Triceps skin-fold thickness (TSF )(r = – .56, p < .01), Mid-arm arm muscle circumference (MAMC) (r = – .43, p = .01) and Body mass index, (BMI) (r = – .48, p = .02). These anthropometric measurements decreased as the patients became malnourished.
Conclusion/Application to practice: The nutritional status of patients affected anthropometric parameters of hemodialysis patients. Anthropometric measurements such as body mass index (BMI), tricep skinfold thickness (TSF) and mid-arm muscle circumference (MAMC), which have been used to assess nutritional status of patients on hemodialysis, are also valid and clinically useful indicators of PEM in HD patients. The importance of adequate patient nutrition should be emphasized with patients and nursing staff dietary counselling should be established for every new dialysis patient.
Disclosure: No conflict of interest declared
O 90
Can an intradialytic exercise programme improve the nutritional status of CKD patients?
R. Camisa1, P. Martins1, M. Agostinho1, N. Gomes1, L. Rosa1, M. Marques1, A. Seabra1, J. Fazendeiro Matos2, M.T. Parisotto3
1NephroCare Coimbra, Fresenius Medical Care, Coimbra, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Porto, Portugal; 3NephroCare Coordination, Fresenius Medical Care, Bad Homburg, Germany
Background: Obesity is a risk factor for kidney disease. Immobility and catabolism caused by the kidney disease induce a loss of muscle mass and a higher fat mass index affecting the quality of life, autonomy, and self-image of patients.
Objectives: To assess the influence of an intradialytic aerobic exercise programme on the nutritional status and analyse the best type of exercise in order to improve the nutritional status of patients.
Methods: In a private dialysis unit in Coimbra (Portugal) we performed a randomised controlled study with 55 patients: 30 in the control group and 25 in the experimental group. These patients were considered fit enough to perform the exercise after assessment of their electrocardiogram and echocardiogram. The nutritional status was assessed by means of bioimpedance spectroscopy before and after the training. Patients were instructed to perform an intradialytic aerobic exercise programme on a cycle ergometer during the first two hours of treatment over 12 weeks. The duration of the exercise was gradually increased to 30 minutes.
Results: Despite slight improvements there were no significant statistical changes in the patients’ lean tissue mass, fat mass, body mass index, lean tissue, and fat tissue index.
Conclusion/Application to practice: Aerobic exercises do not seem to be effective on improving the patients’ nutritional status. We will develop a programme that will also include strength exercises and will re-evaluate the influence of this variable. To enhance our results and provide multidisciplinary care, we will invite our nutritionist to join the project team.
Disclosure: No conflict of interest declared