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      Effect of Nocturnal Haemodialysis on Body Composition

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          Abstract

          Background: Haemodialysis patients have a high risk of malnutrition which is associated with increased mortality. Nocturnal haemodialysis (NHD) is associated with a significant increase in protein intake compared with conventional haemodialysis (CHD). It is unclear whether this leads to improved nutritional status. Therefore, we studied whether 1 year of NHD is associated with a change in body composition. Methods: Whole-body composition using dual-energy X-ray absorptiometry (DEXA) and normalised protein catabolic rate (nPCR) were measured in 11 adult patients before and 1 year after the transition from CHD (12 h dialysis/week) to NHD (28-48 h dialysis/week). Similar measurements were performed in a matched control group of 13 patients who stayed on CHD. Differences between groups were analysed with linear mixed models. Results: At baseline, nPCR, total mass, fat-free mass, and fat mass did not differ significantly between the CHD and NHD groups. nPCR increased in the NHD group (from 0.96 ± 0.23 to 1.12 ± 0.20 g/kg/day; p = 0.027) whereas it was stable in the CHD group (0.93 ± 0.21 at baseline and 0.87 ± 0.09 g/kg/day at 1 year, n.s.). The change in nPCR differed significantly between the two groups (p = 0.027). We observed no significant differences in the course of total mass, fat-free mass, and fat mass during the 1-year observation period between the NHD and CHD groups. Conclusions: One year of NHD had no significant effect on body composition in comparison with CHD, despite a significantly higher protein intake in patients on NHD.

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          Most cited references 14

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          Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality, and physical function.

          Dialysis patients are less active and have reduced functional capacity compared to individuals with normal renal function. Muscle atrophy and weakness may contribute to these problems. This investigation was undertaken to quantify the extent of atrophy in the lower extremity muscles, to determine whether defects in muscle specific strength (force per unit mass) or central nervous system (CNS) activation are present, and to assess the relationship between muscle size and physical performance in a group of patients on hemodialysis. Thirty-eight dialysis subjects (aged 55 +/- 15 years) and nineteen healthy sedentary controls (aged 55 +/- 13 years) were enrolled. Magnetic resonance imaging of the lower leg was used to determine the total cross-sectional area (CSA) and the area of contractile and non-contractile tissue of the ankle dorsiflexor muscles. Isometric dorsiflexor strength was measured during a maximal voluntary contraction with and without superimposed tetanic stimulation (N = 22 for dialysis subjects, N = 12 for controls). Physical activity was measured by accelerometry, and gait speed was recorded as a measure of physical performance. Dialysis subjects were weaker, less active, and walked more slowly than controls. Total muscle compartment CSA was not significantly different between dialysis subjects and controls, but the contractile CSA was smaller in the dialysis patients even after adjustment for age, gender, and physical activity. Central activation and specific strength were normal. Gait speed was correlated with contractile CSA. Significant atrophy and increased non-contractile tissue are present in the muscle of patients on hemodialysis. The relationship between contractile area and strength is intact in this population. Muscle atrophy is associated with poor physical performance. Thus, interventions to increase physical activity or otherwise address atrophy may improve performance and quality of life.
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            Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials.

            Relatively little is known about the effects of hemodialysis frequency on the disability of patients with ESRD.
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              Nutritional status evaluation and survival in haemodialysis patients in one centre from Romania.

              Protein-energy wasting is a common complication and an important predictive factor for mortality in chronic dialysis patients. Therefore, nutritional status needs to be regularly assessed in these patients, by using several methods, and, if malnutrition is present, its possible causes should be thoroughly searched for and properly treated. In 149 prevalent haemodialysis patients (82 men, mean age 53.9 +/- 13.7 years), we evaluated the nutritional status by anthropometrics [post-dialysis height (H), body weight (BW), body mass index (BMI), mid-arm circumference (MAC), tricipital skin-fold thickness (TST), mid-arm muscle circumference (MAMC), corrected mid-arm muscle area (cMAMA) and three-category subjective global assessment score (SGA)], biochemical tests [protein equivalent of nitrogen appearance (nPNA), and pre-dialysis serum albumin, creatinine, total cholesterol, bicarbonate and haemoglobin (Hb) levels] and bioelectrical impedance analysis (BIA) to estimate body composition [percent body fat (%BF), fat-free mass (%FFM), body cell mass (%BCM), extracellular mass (%ECM) and the phase angle (PhA)]. Age was found to be positively correlated with BMI (P = 0.001), and inversely correlated with %BCM (P = 0.013). Patients with A-category SGA were significantly younger (50.1 versus 63.7 years) than those with B-category SGA. Patients with diabetes had lower %BCM (32.9 versus 35.9%; P = 0.035) and PhA (5.5 versus 6.9 degrees ; P = 0.0007) than those without diabetes. The presence of heart failure was associated with significantly reduced nPNA (1.17 versus 1.34 g/kg day; P = 0.014), MAMC (22.0 versus 23.6 cm(2); P = 0.041), %BCM (33.0 versus 36.1; P = 0.021), PhA (5.8 versus 7.0 degrees ; P = 0.031), serum albumin (39.7 versus 42.4 g/l; P = 0.013) and serum creatinine (8.1 versus 9.4 mg/dl; P = 0.010), and with a higher percent of B-category SGA (47.8% versus 22.6%; P = 0.019). Eleven deaths (7.4%) occurred during the follow-up period. Among general factors, age >or= 55, the presence of diabetes, and dialysis vintage or=55 years, the presence of diabetes, nPNA <1.2 g/kg day, lower SGA score, %BF <15% and PhA <6 degrees were associated with significantly increased death risk.
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                Author and article information

                Journal
                NEC
                Nephron Clin Pract
                10.1159/issn.1660-2110
                Nephron Clinical Practice
                S. Karger AG
                1660-2110
                2014
                December 2014
                06 November 2014
                : 128
                : 1-2
                : 171-177
                Affiliations
                aDialysis Center Groningen, bProfessorship in Health Care and Nursing - Hanze University Groningen, University of Applied Sciences, cDepartment of Internal Medicine, Division of Nephrology, dDepartment of Rehabilitation Medicine, Center for Rehabilitation, and eDepartment of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, The Netherlands
                Author notes
                *Karin J.R. Ipema, Dialysis Center Groningen, PO Box 910, NL-9700 AX Groningen (The Netherlands), E-Mail k.ipema@dcg.nl
                Article
                368239 Nephron Clin Pract 2014;128:171-177
                10.1159/000368239
                25376526
                © 2014 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: 3, Pages: 7
                Categories
                Original Paper

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