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      Diagnosis of Protein Calorie Malnutrition in Diabetic Patients on Hemodialysis and Peritoneal Dialysis

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          Abstract

          43 diabetic patients on hemodialysis (n = 26) and peritoneal dialysis (n = 17) underwent nutritional assessment by weight, midarm muscle circumference (MAMC), serum albumin, transferrin, prealbumin (PA) and retinol-binding protein (RBP). Serum ferritin was measured as an index of iron stores. The mean age was 48.5 years (range 26–76 years); mean length of diabetes was 22.8 years (range 9–50 years), and mean length of dialysis was 11.6 months (range 1–48 months). At the onset of dialysis 8 subjects (19%) were below 85% ideal weight and the mean serum albumin was 3.2 ± 0.4 g/dl. By the time of nutritional assessment 11 subjects (26%) were below 85% ideal weight, 19 subjects (44%) had a MAMC less than the 5th percentile, the mean serum albumin was 3.6 ± 0.5 g/dl, the mean serum transferrin was 124 ± 36 mg/dl, the mean PA was 330 ± 100 µg/ml and the mean RBP was 142 ± 25 µg/ml. There was a significant increase in serum albumin from 3.2 ± 0.4 to 3.6 ± 0.5 g/dl (p < 0.001) during the time of dialysis. Transferrin was low in 88% of the subjects and was negatively correlated with serum ferritin, but not with change in weight or serum albumin. RBP was elevated and PA was normal or elevated in all subjects regardless of nutritional status. By conventional nutritional assessment there is widespread malnutrition in diabetic patients on dialysis with 26% below 85% ideal weight, 41% with a serum albumin less than 3.5 g/dl and 42% with a MAMC less than the 5th percentile. The usual sensitive indicators of visceral protein status, serum transferrin, PA, and RBP, are not useful in dialyzed patients.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          978-3-8055-3675-2
          978-3-318-02021-2
          1660-8151
          2235-3186
          1983
          1983
          03 December 2008
          : 33
          : 2
          : 127-132
          Affiliations
          Nutrition Support Service, New England Deaconess Hospital and the Joslin Clinic, Boston, Mass., USA
          Article
          182926 Nephron 1983;33:127–132
          10.1159/000182926
          6403883
          © 1983 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
          Pages: 6
          Categories
          Original Paper

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