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      Association between Dialysis Dose Improvement and Nutritional Status among Hemodialysis Patients

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          Background: Several studies suggest an association between improved survival and better nutritional status. It has been suggested that there is a correlation between dose of dialysis and nutritional status. However, in spite of the current practice, there are conflicting reports regarding the relationship between dose of dialysis or malnutrition, and biochemical outcome. In this article, we will discuss the impact of dose of dialysis on nutritional status and biochemical outcome in hemodialysis patients. We will also mention the interrelationships of dialysis dose, malnutrition, and biochemical outcome with respect to these patients. Methods: Data were processed on 134 dialysis patients (mean age 48.21 ± 13.38, 69 male, 65 female) on 3-times-per-week dialysis regimens. The overall study period was 3 months from June 1, 2005 to August 31, 2005. The patients were divided into two groups: the baseline group and the intervention group. The data of the baseline group were collected in June, 2005 and the data of the intervention group were collected in August, 2005 after applying the intervention or a protocol for dialysis adequacy improvement. Results: The statistical analysis demonstrated that there was a significant improvement in mean URR and Kt/V from the baseline to the intervention group. The intervention group had a considerably higher rate than the baseline group for all nutritional and biochemical outcome parameters. The study showed a strong positive correlation between nPCR and Kt/V (p = 0.0001) and also a strong positive correlation between serum albumin and Kt/V (p = 0.00001). No correlations were found between Kt/V and biochemical outcomes such as hemoglobin (p = 0.4922), calcium (p = 0.650), phosphate (p = 0.508), and phosphatase (p = 0.091). Conclusion: All the available evidence in hemodialysis patients confirms the close association between dialysis dose and biochemical outcome. A body of evidence also highlights the existence of relationship between malnutrition and outcome among these patients. Dose of dialysis and nutrition are considered to be interrelated.

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          The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis.

          Among patients with end-stage renal disease who are treated with hemodialysis, solute clearance during dialysis and nutritional adequacy are determinants of mortality. We determined the effects of reductions in blood urea nitrogen concentrations during dialysis and changes in serum albumin concentrations, as an indicator of nutritional status, on mortality in a large group of patients treated with hemodialysis. We analyzed retrospectively the demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, and urea reduction ratio (defined as the percent reduction in blood urea nitrogen concentration during a single dialysis treatment) in 13,473 patients treated from October 1, 1990, through March 31, 1991. The risk of death was determined as a function of the urea reduction ratio and serum albumin concentration. As compared with patients with urea reduction ratios of 65 to 69 percent, patients with values below 60 percent had a higher risk of death during follow-up (odds ratio, 1.28 for urea reduction ratios of 55 to 59 percent and 1.39 for ratios below 55 percent). Fifty-five percent of the patients had urea reduction ratios below 60 percent. The duration of dialysis was not predictive of mortality. The serum albumin concentration was a more powerful (21 times greater) predictor of death than the urea reduction ratio, and 60 percent of the patients had serum albumin concentrations predictive of an increased risk of death (values below 4.0 g per deciliter). The odds ratio for death was 1.48 for serum albumin concentrations of 3.5 to 3.9 g per deciliter and 3.13 for concentrations of 3.0 to 3.4 g per deciliter. Diabetic patients had lower serum albumin concentrations and urea reduction ratios than nondiabetic patients. Low urea reduction ratios during dialysis are associated with increased odds ratios for death. These risks are worsened by inadequate nutrition.
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            The hemodialysis pilot study: Nutrition program and participant characteristics at baseline


              Author and article information

              Am J Nephrol
              American Journal of Nephrology
              S. Karger AG
              April 2007
              15 February 2007
              : 27
              : 2
              : 113-119
              aBiomedical Engineering, HTI, 10th of Ramadan City, and bDepartment of Systems and Biomedical Engineering, Cairo University, Giza, cNephrology Department, Ahmad Maher Teaching Hospital, Cairo, Egypt
              99836 Am J Nephrol 2007;27:113–119
              © 2007 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 3, Tables: 4, References: 12, Pages: 7
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/99836
              In-Depth Topic Review

              Cardiovascular Medicine, Nephrology

              Nutrition, Hemodialysis, Dialysis adequacy Kt/V


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