The effects of olive oil and flaxseed oil for the treatment of constipation in patients with chronic kidney disease undergoing hemodialysis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)BV UNIFESP: Teses e dissertaçõe

Conhecimento sobre hiperfosfatemia, ingestão alimentar e níveis séricos de fósforo de pacientes em hemodiálise / Knowledge about hyperphosphatemia, food intake and serum phosphorus levels in hemodialysis patients

Introdução: A hiperfosfatemia (fósforo sérico >5,5mg/dL) faz parte do distúrbio mineral e ósseo da doença renal crônica (DMO-DRC), relacionado com pior qualidade de vida e maior mortalidade na hemodiálise. A alimentação é fundamental no tratamento e conhecer fatores associados à hiperfosfatemia podem auxiliar o nutricionista na educação nutricional. Objetivo: Avaliar a relação entre o conhecimento sobre hiperfosfatemia, ingestão alimentar e níveis séricos de fósforo em pacientes em hemodiálise. Métodos: Estudo transversal, com amostra de conveniência. Foi aplicado um questionário contendo 18 perguntas objetivas para avaliar o conhecimento dos pacientes sobre hiperfosfatemia e seu tratamento, inclusive nutricional. O consumo foi obtido por questionário de frequência alimentar, adaptado para capturar apenas alimentos fontes de fósforo. Considerou-se como frequente consumo do alimento ?2x/semana. Resultados: Dos 32 pacientes avaliados, 53,1% eram mulheres, a idade média foi 56,3±15,5 anos e índice de massa corporal mediano de 22,2 (20,7-25,2)Kg/m². Para análise estatística, a amostra foi dividida em tercis de fosfatemia [T1:<4,7mg/dL (n=10); T2:4,7-5,8 mg/dL (n=12) e T3:> 5,8mg/dL (n=10)]. Pacientes do T3 eram mais jovens e apresentavam maior ingestão proteica do que os demais tercis. A mediana de acertos do questionário foi 56,8 (51,4 – 66,9)%, não diferindo significativamente entre grupos. Em relação à alimentação, pacientes do terceiro tercil apresentaram maior ingestão proteica, maior frequência de consumo regular de suco em pó (T1:0%, T2:16,7%, T3:60%; p<0,01) e embutidos (T1:10%, T2:16,7%, T3:60%; p=0,02). Conclusão: O conhecimento dos pacientes sobre hiperfosfatemia foi mediano e não se associou com os níveis séricos de fósforo. O fato da média de ingestão proteica dos pacientes com hiperfosfatemia encontrar-se próxima à recomendação, reforça o impacto do consumo de fósforo inorgânico sobre a fosfatemia.

Constipation in Chronic Kidney Disease: It Is Time to Bridge the Gap

In this narrative review, we briefly describe the general features of constipation, our understanding of its physiopathology, and its diagnosis and treatment, focusing on chronic kidney disease (CKD). Considering that constipation is poorly characterized in CKD, we referred to studies that used the Rome criteria to diagnose constipation in patients to describe a more realistic prevalence based on a standardized tool. A highly variable prevalence of the condition was reported, ranging from 4.5% to 71.7%. The main risk factors associated with constipation reported in these studies were advanced age, low fruit intake, presence of diabetes, and medication use, and the main consequence of constipation in CKD was a worse quality of life. We found a paucity of interventional studies for constipation treatment in CKD; however, in the general population, meta-analyses published in the last decade have reported the beneficial effects of non-pharmacological strategies, which may guide the management of constipated patients with CKD. These strategies include the consumption of fiber, prebiotics, and probiotics, as well as physical exercise and acupuncture. In conclusion, although constipation is a frequent complaint among patients with CKD, there remains a considerable knowledge gap regarding its epidemiology, prognosis, and treatment

Subjective Global Assessment for the Diagnosis of Protein-Energy Wasting in Nondialysis-Dependent Chronic Kidney Disease Patients

Objectives: Subjective global assessment (SGA) has been demonstrated to be a reliable method for protein-energy wasting (PEW) evaluation in chronic kidney disease (CKD) patients on dialysis. Few data are available on PEW evaluation in nondialysis stages of CKD, and the validity of SGA has been scarcely investigated in this population. Herein, we aimed to evaluate in nondialysis-dependent CKD patients (NDD-CKD): (1) the prevalence of PEW by SGA; (2) the most common abnormalities of the SGA components; and (3) the agreement of SGA with the traditional anthropometric parameters.Design and Subjects: This is a retrospective cross-sectional study including 922 NDD-CKD patients referred to the renal dietitians in the period of 2001 to 2012. Nutritional status was assessed by 7-point SGA. Body mass index (BMI), midarm circumference, midarm muscle circumference, and triceps skinfold thickness were available from 494 patients.Results: From the 922 patients, 58.6% were men, mean age was 63.8 +/- 13.6 years, BMI was 27.7 +/- 5.3 kg/m(2). the majority of the patients were in CKD Stages 3 (48.9%) or 4 (40.3%). PEW (SGA <= 5) was present in 11% of the patients and 32% had signs of PEW (SGA 6). in the logistic regression analysis, the presence of comorbidities and worse renal function were independently associated with PEW. Among the SGA components, the most frequent abnormality in patients with PEW was muscle and fat wasting (88.6%). BMI, midarm circumference, midarm muscle circumference, and triceps skinfold thickness were lower across the worse SGA scores, and a moderate to good level of agreement was found between the anthropometric parameters and presence of PEW evaluated by SGA.Conclusions: the prevalence of PEW was 11% in our unselected cohort of NDD-CKD patients. the physical examination component (muscle/fat wasting) was the most frequent alteration found in those patients. When compared with anthropometric parameters, 7-point SGA has shown to be a valid tool to assess PEW in NDD-CKD population. (C) 2014 by the National Kidney Foundation, Inc. All rights reserved.Oswaldo Ramos FoundationUniversidade Federal de São Paulo, Div Nephrol, Dept Med, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Grad Program Nutr, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, Dept Med, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Grad Program Nutr, BR-04039000 São Paulo, BrazilWeb of Scienc

Influence of nutritional status, laboratory parameters and dietary patterns upon urinary acid excretion in calcium stone formers.

<div><p>ABSTRACT Introduction: Obesity and Metabolic Syndrome (MS) are associated with low urinary pH and represent risk factors for nephrolithiasis, especially composed by uric acid. Acidogenic diets may also contribute to a reduction of urinary pH. Propensity for calcium oxalate precipitation has been shown to be higher with increasing features of the MS. Objective: A retrospective evaluation of anthropometric and body composition parameters, MS criteria and the dietary patterns of overweight and obese calcium stone formers and their impact upon urinary pH and other lithogenic parameters was performed. Methods: Data regarding anthropometry, body composition, serum and urinary parameters and 3-days dietary records were obtained from medical records of 102(34M/68F) calcium stone formers. Results: A negative correlation was found between urinary pH, waist circumference and serum uric acid levels (males). The endogenous production of organic acids (OA) was positively correlated with triglycerides levels and number of features of MS (males), and with glucose, uric acid and triglycerides serum levels, and number of features of MS (females). No significant correlations were detected between Net Acid Excretion (NAE) or Potential Renal Acid Load of the diet with any of the assessed parameters. A multivariate analysis showed a negative association between OA and urinary pH. Conclusion: The endogenous production of OA and not an acidogenic diet were found to be independently predictive factors for lower urinary pH levels in calcium stone formers. Hypercalciuric and/or hyperuricosuric patients presented higher OA levels and lower levels of urinary pH.</p></div

Influence of nutritional status, laboratory parameters and dietary patterns upon urinary acid excretion in calcium stone formers.

<div><p>ABSTRACT Introduction: Obesity and Metabolic Syndrome (MS) are associated with low urinary pH and represent risk factors for nephrolithiasis, especially composed by uric acid. Acidogenic diets may also contribute to a reduction of urinary pH. Propensity for calcium oxalate precipitation has been shown to be higher with increasing features of the MS. Objective: A retrospective evaluation of anthropometric and body composition parameters, MS criteria and the dietary patterns of overweight and obese calcium stone formers and their impact upon urinary pH and other lithogenic parameters was performed. Methods: Data regarding anthropometry, body composition, serum and urinary parameters and 3-days dietary records were obtained from medical records of 102(34M/68F) calcium stone formers. Results: A negative correlation was found between urinary pH, waist circumference and serum uric acid levels (males). The endogenous production of organic acids (OA) was positively correlated with triglycerides levels and number of features of MS (males), and with glucose, uric acid and triglycerides serum levels, and number of features of MS (females). No significant correlations were detected between Net Acid Excretion (NAE) or Potential Renal Acid Load of the diet with any of the assessed parameters. A multivariate analysis showed a negative association between OA and urinary pH. Conclusion: The endogenous production of OA and not an acidogenic diet were found to be independently predictive factors for lower urinary pH levels in calcium stone formers. Hypercalciuric and/or hyperuricosuric patients presented higher OA levels and lower levels of urinary pH.</p></div

Impacto da sessão de hemodiálise na força de preensão manual

Resumo Introdução: A força de preensão manual (FPM) é um método simples, confiável e com bom valor preditivo para avaliar a função muscular de pacientes submetidos à hemodiálise (HD). Porém, ainda não existe um consenso a respeito do momento mais apropriado para a aferição da medida, já que o desempenho da FPM pode ser influenciado pelas flutuações hidroeletrolíticas e de pressão arterial que acometem esses pacientes. Objetivo: Investigar o impacto da sessão de diálise sobre a FPM em pacientes submetidos à HD. Métodos: Trata-se de um estudo transversal com 156 pacientes [57,7% homens, idade mediana de 56,5 (42-67) anos, 28,8% diabéticos, IMC médio de 24,75 ± 4,5 kg/m2 e tempo em HD de 38 (19,25-72,75) meses]. Foram realizadas aferições da FPM com um dinamômetro nos minutos iniciais e ao término da sessão de HD. Os valores obtidos foram comparados com um padrão de referência nacional. Dados clínicos, demográficos e laboratoriais foram coletados do prontuário médico. Resultados: Foi observada uma redução significante da FPM após a sessão de HD (28,6 ± 11,4 kg para 27,7 ± 11,7 kg; p < 0,01). A prevalência de pacientes com FPM abaixo do percentil 30 aumentou de 44,9% para 55,1% (p < 0,01). A redução da pressão arterial durante a diálise foi o único fator que se associou com a redução da FPM. Conclusão: Os achados mostram que o processo de HD influencia negativamente a FPM

Bowel Habits and the Association With Uremic Toxins in Non–Dialysis-Dependent Chronic Kidney Disease Patients

Objective: The aim of this study is to evaluate the association between bowel habits and microbial-derived uremic toxins p-cresyl sulfate (PCS) and indoxyl sulfate (IS) in patients with non–dialysis-dependent chronic kidney disease (NDD-CKD). Design and Methods: This is a cross-sectional analysis including 43 nondiabetic NDD-CKD patients (58% men; 59.0 ± 13.5 years; estimated glomerular filtration rate, 21.3 ± 7.9 mL/min/1.73 m). Bowel habit was assessed by the Bristol Stool Scale (BS