The Evaluation of Increase in Hemodialysis Frequency on C-Reactive Protein Levels and Nutritional Status
,
Abstract
Malnutrition and inflammation are the most important causes of cardiovascular disease in hemodialysis patients. This study was conducted to evaluate the effect of increase in hemodialysis frequency on C-reactive protein (CRP) level and nutritional markers in contrast to previous routine method. 18 hemodialysis patients with a mean age of 53±16 years were randomly selected in this before-and-after clinical trial. The patients under a standard hemodialysis of 3 times/4 h per week were converted to 4 times/4 h for a period of 6 weeks. The CRP, albumin, triglyceride, total cholesterol, LDL, HDL serum levels, anthropometric indices and 24-h diet recall intake was assessed before and after of the period. The data were analyzed using paired t-test, and P-value less than 0.05 was considered significant. All patients completed the study. Mean weight, body mass index and serum albumin increased while serum CRP level decreased significantly after the intervention (P<0.03). Triglyceride, total cholesterol, LDL, HDL, as well as energy, protein and fat intake had no significant change before and after the study. Increase in dialysis frequency decreased systemic inflammation and improved the nutritional state of hemodialysis patients. Therefore, it may decrease the risk of cardiovascular events in these patients.
Chazot C, Jean G. The advantages and challenges of increasing the duration and frequency of maintenance dialysis sessions. Nat Clin Pract Nephrol 2009;5(1):34-44.
FHN Trial Group, Chertow GM, Levin NW, Beck GJ, Depner TA, Eggers PW, Gassman JJ, Gorodetskaya I, Greene T, James S, Larive B, Lindsay RM, Mehta RL, Miller B, Ornt DB, Rajagopalan S, Rastogi A, Rocco MV, Schiller B, Sergeyeva O, Schulman G, Ting GO, Unruh ML, Star RA, Kliger AS. In-Center Hemodialysis Six Times per Week versus Three Times per Week. N Engl J Med 2010;363(24):2287-300.
Valderrabano F, Jofre R, Lopez-Gomez JM. Quality of life in end-stage renal disease patients. Am J Kidney Dis. 2001;38(3):443–64.
Walters BA, Hays RD, Spritzer KL, Fridman M, Carter WB. Health-related quality of life. depressive symptoms. anemia. and malnutrition at hemodialysis initiation. Am J Kidney Dis 2002;40(6):1185–94.
Tirmentajn-Jankovic B, Dimkovic N. Simple methods for nutritional status assessment in patients treated with repeated hemodialysis. Med Pregl 2004;57(9-10): 39-44.
Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G. Comparing outcome predictability of markers of= malnutrition–inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant 2004;19(6):1507-19.
Rysz J, Banach M, Cialkowska-Rysz A, Stolarek R, Barylski M, Drozdz J, Okonski P. Blood Serum Levels of IL-2. IL-6. IL-8. TNF-α and IL-1β in Patients on Maintenance Hemodialysis. Cell Mole Immuno 2006;3(2):151-4.
Antonio S, Elena M. Cardiac effects of chronic inflammation in dialysis patients. Nephrol Dial Transplant 2002; 17 Suppl:10-5.
Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD. Malnutrition-Inflammation Complex Syndrome in Dialysis Patients: Causes and Consequences. Am J Kid Dis 2003; 42(5):864-881.
Korevaar JC, van Manen JG, Dekker FW, de Waart DR, Boeschoten EW, Krediet RT; NECOSAD study group. Effect of an Increase in C-Reactive Protein Level during a Hemodialysis Session on Mortality. J Am Soc Nephrol2004;15(11):2916–22.
Yao Q, Lindholm B, Stenvinkel P. Inflammation as a cause of malnutrition. Atherosclerotic cardiovascular disease and poor outcome in hemodialysis patients. Hemodial Int 2004;8(2):118-29.
Fernández-Reyes MJ, Alvarez-Ude F, Sánchez R, Mon C, Iglesias P, Díez JJ, Vázquez A. Inflammation and malnutrition as predictors of mortality in patients on hemodialysis. J Nephrol 2002;15(2):136-43.
Teixeira Nunes F, de Campos G, Xavier de Paula SM, Merhi VA, Portero-McLellan KC, da Motta DG, de Oliveira MR. Dialysis adequacy and nutritional status of hemodialysis patients. Hemodial Int 2008;12(1):45–51.
de Mutsert R, Grootendorst DC, Indemans F, BoeschotenEW, Krediet RT, Dekker FW; Netherlands Cooperative Study on the Adequacy of Dialysis-II Study Group. Association between serum albumin and mortality in dialysis patients is partly explained by inflammation, and not by malnutrition. J Ren Nutr 2009;19(2):127-35.
Kalantar-Zadeh K.Recent Advances in Understanding the Malnutrition- Inflammation-Cachexia Syndrome in Chronic Kidney Disease Patients: What is Next? Seminars in Dialysis 2005;18(5):365–69.
Stenvinkel P. Inflammation in end-stage renal failure: could it be treated? Nephrol Dial Transplant. 2002;17 Supple 8:33–8.
Amore A, Coppo R. Immunological basis of inflammation in dialysis. Nephrol Dial Transplant 2002;17 Supple 8:16–24.
Kaysen GA. The Microinflammatory State in Uremia: Causes and Potential Consequences. J Am Soc Nephrol 2001;12(7):1549–57.
Don BR, Kaysent G. Serum albumin: Relationship to inflammation and nutrition. Semin Dial 2004;17(6):432–7.
Ateş K, Yilmaz O, Kutlay S, Ateş A, Nergizoğlu G, Erturk S. Serum C-reactive Protein Level Is Associated with Renal Function and It Affects Echocardiographic Cardiovascular Disease in Pre-Dialysis Patients. Nephron Clin Pract 2005;101(4):190–7.
Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C: Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 1999;55(2):648-58.
de Mutsert R, Grootendorst DC, Axelsson J, Boeschoten EW, Krediet RT, Dekker FW; NECOSAD Study Group. Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transplant 2008;23(9):2957–64.
de Mutsert R, Grootendorst DC, Indemans F, Boeschoten EW, Krediet RT, Dekker FW; Netherlands Cooperative Study on the Adequacy of Dialysis-II Study Group. Association between serum albumin and mortality in dialysis patients is partly explained by inflammation, and not by malnutrition. J Ren Nutr 2009; 19(2):127–35.
Morbidity and mortality of dialysis. NIH Consens Statement 1993;11(2):1-33.
Depner TA. Daily hemodialysis effi- ciency: an analysis of solute kinetics. Adv Ren Replace Ther 2001;8(4):227-35.
Doumas BT, Watson WA, Biggs HG. Albumin standards and the measurement of serum albumin with bromcresol green. Clin Chim Acta 1971;31(1):87-96.
Suri RS, Nesrallah GE, Mainra R, Garg AX, Lindsay RM, Greene T, Daugirdas JT. Daily hemodialysis: a systematic review. Clin J Am Soc Nephrol 2006;1(1):33-42.
Walsh M, Culleton B, Tonelli M, Manns B. A systematic review of the effect of nocturnal hemodialysis on blood pres- sure, left ventricular hypertrophy, anemia, mineral metabolism, and health-related quality of life. Kidney Int 2005;67(4):1500-8.
Buoncristiani U, Quintaliani G, Coz- zari M, Giombini L, Ragaiolo M. Daily dialysis: long-term clinical metabolic re- sults. Kidney Int Suppl 1988;24:S137-40.
Ting GO, Kjellstrand C, Freitas T, Carrie BJ, Zarghamee S. Long-term study of high-comorbidity ESRD patients con- verted from conventional to short daily hemodialysis. Am J Kidney Dis 2003;42(5):1020-35.
Ayus JC, Mizani MR, Achinger SG, Thadhani R, Go AS, Lee S. Effects of short daily versus conventionalhemodialysis on left ventricular hypertrophy and inf lammatory markers: a prospective, controlled study. J Am Soc Nephrol 2005;16(9):2778-88.
Hecking E, Bragg-Gresham JL, Rayner HC, Pisoni RL, Andreucci VE, Combe C, Greenwood R, McCullough K, Feldman HI, Young EW, Held PJ, Port FK. Hemodialysis prescription, adherence and nutritional indica- tors in five European countries: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2004;19(1):100-7.
Clinical prac- tice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2000;35(6 suppl 2):S1-140.
Kimmel PL, Varela MP, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Amarashinge A, Mishkin GJ, Cruz I, Veis JH. Interdialyticweightgainand survival in hemodialysis patients: effects of duration of ESRD and diabetes mellitus. Kidney Int 2000;57(3):1141–51.
Lopez-Gomez JM. Inter dialytic weight gain as a marker of blood pressure, nutrition, and survival in hemodialysis patients. Kidney Int Suppl 2005;93:S63–80
Pifer TB, McCullough KP, Port FK, Goodkin DA, Maroni BJ, Held PJ, Young EW. Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney Int 2002;2(6):2238-45.
Galland R, Traeger J, Arkouche W, Cleaud C, Delawari E,Fouque D. Short daily hemodialysis rapidly improves nutritional status in hemodialysis patients. Kidney Int 2001;60(4):1555-60.
Chazot C, Jean G. The advantages and challenges of increasing the duration and frequency of maintenance dialysis sessions. Nat Clin Pract Nephrol 2009;5(1):34-44.
Okada K, Abe M, Hagi C, Maruyama T, Maruyama N, Ito K, Higuchi T, Matsumoto K, Takahashi S. Prolonged protective effect of short daily hemodialysis against dialysis-induced hypotension. Kidney Blood Press Res 2005;28(2):68–76.
Kalantar-Zadeh K, Kilpatrick RD, Kuwae N, McAllister CJ, Alcorn H Jr, Kopple JD, Greenland S. Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and popula- tion-attributable fraction. Nephrol Dial Transplant 2005;20(9):1880-8.
Port FK, Pisoni RL, Bragg-Gresham JL, Satayathum SS, Young EW, Wolfe RA, Held PJ. DOPPS estimates of patient life years attributable to modifiable hemodialysis practices in the United States. Blood Purif 22(1):175-80.
Yang C-S, Chen S-W, Chiang C-H, Wang M, Peng S-J, Kan Y-T. Effects of increasing dialysis dose on serum albumin and mortality in hemodialysis patients. Am JKidney Dis 1996;27(3):380–6.
Goldfarb-Rumyantzev AS, Leypoldt JK, Nelson N, Kutner NG, Cheung AK. A crossover study of short daily haemodialysis. Nephrol Dial Transplant 2006;21(1):166–75.
Galland R, Traeger J, Arkouche W, Cleaud C, Delawari E,Fouque D. Short daily hemodialysis rapidly improves nutritional status in hemodialysis patients. Kidney Int 2001;60(4):1555–60.
Kloppenburg WD, Stegeman CA, Hovinga TK, Vastenburg G, Vos P, de Jong PE, Huisman RM. Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients: a randomized, controlled trial. Nephrol Dial Transplant 2004;19(5):1212–23.
Avesani CM, Kamimura MA, Cuppari L. Energy expenditure in chronic kidney disease patients. J Ren Nutr 2011;21(1):27-30.
Fouque D, Pelletier S, Mafra D, Chauveau P. Nutrition and chronic kidney disease. Kidney International 2011;80:384-57.
Ayus J, Mizani R, Achinger S, Thadhani R, Go A, Lee S. Effects of Short Daily versus Conventional Hemodialysis on Left Ventricular Hypertrophy and Inflammatory Markers: A Prospective. Controlled Study. J Am Soc Nephrol 2005;16(9):2778–88.
Ortega O. Could We Reduce the Prevalence of Inflammation among Patients with Chronic Kidney Disease? Nephron Clin Pract. 2005; 101(4):198–199.
Korevaar JC, van Manen JG, Dekker FW, de Waart DR, Boeschoten EW, Krediet RT; NECOSAD study group. Effect of an Increase in C-Reactive Protein Level during a Hemodialysis Session on Mortality. J Am Soc Nephrol 2004;15(11):2916–22.
Kaysen GA. Role of inflammation and its treatment in ESRD patients. Blood Purif 2002;20(1):70-80.
Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Treviño-Becerra A, Wanner C. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008; 73(4):391–8.
Avesani CM, Draibe SA, Kamimura MA, Colugnati FA, Cuppari L. Resting energy expenditure of chronic kidney disease patients: influence of renal function and subclinical inflammation. Am J Kidney Dis 2004;44(6):1008–16.
Kalantar-Zadeh K, Block G, McAllister CJ, HumphreysMH, Kopple JD. Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr 2004; 80(2):299–307.
Carrero JJ, Qureshi AR, Axelsson J, Avesani CM, Suliman ME, Kato S, Bárány P, Snaedal-Jonsdottir S, Alvestrand A, Heimbürger O, Lindholm B, Stenvinkel P. Comparison of nutritional and inflammatory markers in dialysis patients with reduced appetite. Am J Clin Nutr 2007;85(3):695–701.
| Files | ||
| Issue | Vol 51, No 2 (2013) | |
| Section | Articles | |
| Keywords | ||
| CRP Hemodialysis Nutritional status | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
