RELATIONSHIP BETWEEN SALT INTAKE AND GNRI IN ELDERLY DIALYSIS PATIENTS

While the recommended salt intake in dialysis patients is no more than 5g/day in the KDOQI guideline, and 6g/day in the JSH 2009 guideline, reducing salt consumption is difficult on the traditional Japanese diet. If a patient is malnourished, a low-salt diet poses a risk of aggravating the nutritional deficiency. Since elderly dialysis patients have nutritional deficiencies underlying their condition, the recommended low-salt diet may prevent these patients from receiving adequate nutrition. In the present study, factors associated with nutritional status in the elderly were assessed using the Geriatric Nutritional Risk Index (GNRI), which is considered to correlate with predictor of mortality among dialysis patients. Participating patients were anuric, had been maintained on dialysis for at least 2 years, and were 65 years of age or older. Factors assessed for their possible correlations with GNRI were primary disease, presence of spouse, presence of cohabiting family, weight gain, and estimated salt intake. We analyzed 36 patients (age 74.3±5.4 years, 50% males). GNRI was 90.9±7.7, and salt intake (8.02±1.94) correlated with GNRI (r=0.41, P=0.02). No correlations were detected for the presence of spouse or cohabiting family, which would have contributed to nutrition. In conclusion, the higher the salt intake, the better GNRI tended to be. This raised the possibility that it would be advantageous to avoid excessive salt restriction in nutritional training

examination of the effects of liraglutide on diabetic nephropathy

Liraglutide (Lira), a glucagon-like peptide-1 receptor agonist, can be administered to diabetic patients with renal failure without dose reduction, but experience with the use of Lira in these patients is limited. This study was designed to examine the effects of 6-month Lira administration on glucose metabolism, body mass index (BMI), and renal function in 18 patients with diabetic nephropathy (eGFR <60 ml/min). The study included 18 patients with diabetic nephropathy who were on insulin/oral hypoglycemic medications (6 men, 12 women; average age, 60 years; HbA1c, 8.4%; BMI, 29.4 ± 8.2; duration of diabetes, 12 years; eGFR, 55.2 ± 6.3 ml/min/1.73 m2). Lira was given either in combination or as monotherapy. After 6 months of Lira treatment, changes in HbA1c levels, casual blood glucose levels, BMI, and eGFR were examined. The average HbA1c and casual blood glucose levels were significantly decreased after 6-month Lira administration (HbA1c before administration 8.4%, 7.9% at Month 1, 7.4% at Month 2, 7.1% at Month 3, 7.1% at Month 6; p < 0.01 respectively, Paired T test). There were, however, no significant changes in renal function. In conclusion, these results suggest that the administration of Lira in patients with diabetic nephropathy may improve glucose metabolism and reduce BMI without affecting renal function or albuminuria in the short term