Nutrition in hemodialysis patients previously on a supplemented very low protein diet

Nutrition in hemodialysis patients previously on a supplemented very low protein diet.BackgroundNutritional safety of protein-restricted diets in patients with chronic renal failure is controversial. In the present study, we have assessed the evolution of nutritional status after initiation of hemodialysis in patients previously treated by a supplemented very low protein diet (SVLPD).MethodsNutritional data were prospectively collected during the first year of hemodialysis from 15 consecutive patients treated with a SVLPD (0.3 g protein/kg/day supplemented with essential amino acids, calcium, iron, and vitamins) and compared to 15 age- and gender-matched end-stage renal disease (ESRD) patients previously on a less-restricted diet (0.90 ± 0.21 g protein/kg/day) who started hemodialysis during the same period. Dual-energy x-ray absorptiometry (DEXA) was used to assess body composition at 0, 6, and 12 months. Hemodialysis prescriptions, biologic data and 3-day food records were collected every 3 months.ResultsProtein intake was higher than 1.2 g/kg/day in both groups as soon as 3 months after the start of hemodialysis. Albumin and prealbumin increased significantly during the first 6 months in all patients. Body mass index (BMI) increased in all patients (+0.97 ± 1.31 kg/m2; P < 0.001) reflecting a gain in fat mass in the overall population (+2.36 ± 2.94 kg/m2; P < 0.001) while lean body mass remained stable overall.ConclusionOnce on hemodialysis, SVLPD patients rapidly increased protein intake. Nutritional status improved in all patients, with a gain in fat mass in all, and a gain in lean body mass in SVLPD men only. These data indicate that treatment with a SVLPD prior to hemodialysis initiation is nutritionally safe

Devenir des patients de plus de 75 ans à 6 mois après la mise en dialyse (survie, autonomie, état nutritionnel et qualité de vie)

INTRODUCTION : L'incidence de l'insuffisance rénale terminale parmi les patients de plus de 75 ans augmente depuis plusieurs années. La dialyse permet une augmentation de la survie de ces patients mais le bénéfice en termes de qualité de vie et d'autonomie n'est pas clairement établi. OBJECTIF : Evaluation du devenir des patients de plus de 75 ans mis en dialyse au CHU en 2010 en termes de survie, d'autonomie, d'état nutritionnel et de qualité de vie à partir d'un suivi trimestriel. RESULTATS : Vingt-cinq patients ont été ibnclus et suivis les 6 premiers mois après la mise en dialyse. La mortalité est faible à 8 % à 6 mois. Il existe une stabilité de l'autonomie ADL médian à 2 pendant les 6 mois et de l'état cognitif MMS médian à 25 permettant à 68 % d'entre eux de rester au domicile. 67 % avaient un suivi néphrologique antérieur. La dialyse programmée (40 % des patients) est associée à la diminution de la durée d'hospitalisation initiale (p = 0.00016) et à la mise en dialyse sur une FAV (78 %) permettant le transfert des patients en unité d'auto-dialyse (41 % à 6 mois). L'état nutritionnel au MNA s'améliore avec 70 % de patients ayant un bon état nutritionnel à 6 mois contre 28 % à la prise en charge. La qualité de vie s'améliore également au niveau de la santé générale (p = 0,022), de l'énergie (p = 0,047) et de la fonction sociale (p = 0,017). Le suivi néphrologique des patients âgés insuffisants rénaux est essentiel. Il permet de programmer la mise en dialyse, de diminuer les hositalisations, d'éviter le recours au cathéter et de débuter la dialyse avant qu'ils n'aient une altération franche de l'état général. CONCLUSION : Les patients âgés ont une évolution favorable après leur mise en dialyse malgré leurs comorbidités et ce d'autant plus que la mise en dialyse a pu être programmée. Il est donc important d'adresser les patients âgés au néphrologue afin de ne pas restreindre l'accès de ces patients à la dialyse.INTRODUCTION : The incidence of end-stage renal disease among patients over 75 years is increrasing for many years. Dialysis leads to an increase in patients survival but the benefits in terms of quality of life and autonomy is not clear. AIM : The aim of the study is to assess the outcome of patients more than 75 years old beginning dialysis in CHU in 2010 in terms of survival, autonomy, nutritional status and quality of life from quarterly monitoring. RESULTS : Twenty five patients were included and followed-up the first 6 month after starting dialysis. Mortality is low at 8 % at 6 month. There is a stability of autonomy with ADL median score at 2 during 6 month and also no cognitive impairment with median MMS score constant at 25. So 68 % of patients could stay at home. 67 % had an earlier nephrologic follow-up. Scheduled dialysis (40 % of patients) is associated with less duration of initial hospitalisation (p = 0.00016) and initiating of dialysis with arteriovenous fistulae (78 %) and it is helpful to allow patients to dialyse near residence (41 %). Nutritional status with MNA is getting better : 70 % of patients with a good nutritional status at 6 month against 28 % at the beginning. Quality of life is also getting better for general health (p = 0,022), vitality (p = 0,007), bodily pain (p = 0,047), mental health (p = 0,022) and social functioning (p = 0,017). Nephrological follow-up for aged patients with end-stage renal disease is essential. It allows to program the dialysis, to decrease hospitalisations and to avoid the use of catheter and start dialysis before deterioration in health status. CONCLUSION : Elderly patients have a favorable evolution after starting dialysis despite their co-morbidities and especially when dialysis is programmed. It is therefore important to refer these patients to nephrologists.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Statut vitaminique et apports alimentaires des patients hémodialysés

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Differential Uridyl-diphosphate-Glucuronosyl Transferase 1A enzymatic arsenal explains the specific cytotoxicity of resveratrol towards tumor colorectal cells

International audienceResveratrol belongs to the Bioactive Food Component (BFC) family. It seems admitted that its cytotoxic action impacts tumor cells and spares healthy cells, but the published proofs remain rare. We hypothesized that cells may differentially metabolize resveratrol and lead to different systemic impacts. For this, resveratrol metabolization was evaluated by ultra-high-performance liquid chromatography (UHPLC) coupled with diode array detection (DAD), and correlated with the expression of Uridyl-diphosphate-Glucuronosyl Transferase 1A (UGT1A) genes. The expression of UGT1A genes in human colorectal tissues was studied with RNAseq databases. Functional validation of UGT1A enzymes implication in resveratrol sensitivity of colorectal cells established by UGT1A expression modulation. As resveratrol impacts the S phase of the cell cycle, nucleotide metabolic balance was assessed. We found that resveratrol was more cytotoxic in cells with downregulation of UGTs, i.e. tumor cells. Conversely, overexpression of the UGT1A10 gene in an initial resveratrol-sensitive tumor cell line restored the metabolization accompanied by cytotoxicity diminution. Resveratrol affected intestinal sensitive tumor cell homeostasis with a cell growth/proliferation decoupling, cell-cycle modulation, and UXP/AXP nucleotide imbalance resulting in a global reduction of transcription and translation. This impact on global cell activity was restricted to tumor cells. This study improves resveratrol’s general knowledge and explains how its antitumor action can spare non-tumor cells. It also paves the way to select colorectal tumors eligible for resveratrol treatment potentiation without additional toxicity to healthy digestive tissues