Korean Journal of Community Nutrition (대한지역사회영양학회지)

The Korean Society of Community Nutrition (대한지역사회영양학회)
권호 표지

Comparison of Nutritional Status and Inflammational Markers in DM and nonDM Hemodialysis Patients

당뇨와 비당뇨 유지 혈액투석 환자의 영양상태와 염증지표의 상관성 비교

  • Kim, Su-An (Department of Nutrition Care Services, Seoul National University of Bundang Hospital) ;
  • Sohn, Cheong-Min (Department of Nutrition Care Services, Seoul National University of Bundang Hospital) ;
  • Chae, Dong-Wan (Department of Internal Medicine, Seoul National University of Bundang Hospital)
  • 김수안 (분당서울대학교병원 영양실) ;
  • 손정민 (분당서울대학교병원 영양실) ;
  • 채동완 (분당서울대학교병원 내과)
  • Published : 2005.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Protein-calorie malnutrition is common in maintenance dialysis patients. Indeed, diabetic patients with chronic renal failure are considered to be at increased risk of malnutrition. The aim of this study was to compare the nutritional status and markers of inflammation of hemodialysis patients with and without type 2 diabetes. We compared nutritional parameters and C-reactive protein (CRP) as a marker of inflammation in 30 type 2 diabetic patients and age-matched 30 non-diabetic patients with hemodialysis. Serum albumin was significantly lower in patients with type 2 diabetes $(3.45\pm0.43g/dL)$ than in non-diabetic patients $(3.64\pm0.36 g/dL)$ (p<0.05). In contrast, the concentration of serum CRP was significantly higher in type 2 diabetes $(1.42\pm1.8mg/dL)$ (p<0.05). There were significant negative-relationships between serum albumin and CRP level in both diabetic (r=-0.553, p<0.01) and non-diabetic (r=-0.579, p<0.01) patients. In diabetic patients, serum albumin level was significantly correlated with hemoglobin (r = 0.488, p < 0.01) and hematocrit (r=0.386, p < 0.01). Diabetic patients as compared to non-diabetic patients showed a significant (p < 0.01) increased serum triglyceride (TG) $(153.1\pm80.1mg/dL\;vs\;101.6\pm62.4mg/dL)$ and decreased serum HDL cholesterol $(36.89\pm13.48mg/dL\;vs\;47.00\pm14.02mg/dL,\;P<0.05)$. There were significant correlations in the intake of calorie and serum albumin levels in both diabetic (r=0.438, p< 0.05) and non-diabetic (r=0.527, p<0.05) patients. Serum CRP level was negatively correlated with calorie (r= -0.468, p < 0.05), protein (r=-0.520, p < 0.01) and fat intakes (r=-0.403, p < 0.05) in diabetic patients and calorie (r=-0.534, p<0.05) and protein intakes (r=-0.559, p<0.05) in non-diabetic patients. The prevalence of protein malnutrition and the risk factors of cardiovascular disease were significantly higher in type 2 diabetic patients than in non-diabetic hemodialysis patients. Thus, we can suggest that the higher comorbidity and mortality rate in diabetic hemodialysis patients are partially explained by malnutrition and inflammation.

Keywords

References

  1. Biesenbach G, Debska-Slizien A, Zazgornik J (1999): Nutritional status in type 2 diabetic patients requiring haemodialysis. Nephrol Dial Transplant 14(3): 655-658 https://doi.org/10.1093/ndt/14.3.655
  2. Burrowes JD, Cockram DB, Dwyer JT, Larive B, Paranandi L, Bergen C, Poole D (2002): Cross- sectional relationship between dietary protein and energy intake, nutritional status, functional status, and comorbidity in older versus younger hemodialysis patients. Ren Nutr 12(2): 87-95 https://doi.org/10.1053/jren.2002.32209
  3. Cano NJ, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Fouque D, Laville M, Leverve XM (2002): French Study Group for Nutrition in Dialysis (FSG-ND). Malnutrition in hemodialysis diabetic patients: evaluation and prognostic influence. Kidney Int 62(2): 593-601 https://doi.org/10.1046/j.1523-1755.2002.00457.x
  4. Coffman TM, Cheung AK, Falk RJ, Jennette JC, Greenberg A (2001): Primer on Kidney Diseases. Academic press, pp.420-425
  5. Daugirdas JT (1993): Second generation logarithmic estimates of singlepool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 4(5): 1205-1213
  6. Docci D, Bilancioni R, Buscaroli A, Baldrati L, Capponcini C, Mengozzi S, Turci F, Feletti C (1990): Elevated serum levels of C-reactive protein in hemodialysis patients. Nephron 56(4): 364-367 https://doi.org/10.1159/000186176
  7. Foley RN, Parfrey PS, Sarnak MJ (1998): Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 32(5 Suppl 3): S112-S119 https://doi.org/10.1053/ajkd.1998.v32.pm9820470
  8. Grodstein GP, Blumenkrantz MJ, Kopple JD (1980): Nutritional and metabolic response to catabolic stress in uremia. Am J Clin Nutr 33(7): 1411-1416
  9. Ikizler TA, Rebecca L. Wingard, Janice Harvell, Yu Shyr, Raymond M. Hakim (1999): Association of morbidity with markers of nutrition and inflammation in chronic hemodialysis patients: A prospective study. Kidney International 55(5): 1945-1951 https://doi.org/10.1046/j.1523-1755.1999.00410.x
  10. Johansen OE, Birkeland KI (2003): Preventing macrovascular disease in patients with type 2 diabetes mellitus. Am J Cardiovasc Drugs 3(4): 283-297 https://doi.org/10.2165/00129784-200303040-00007
  11. Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD (2003): Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis 42(5): 864-881 https://doi.org/10.1016/j.ajkd.2003.07.016
  12. Khovidhunkit W, Memon RA, Feingold KR, Grunfeld C (2000): Infection and inflammation-induced proatherogenic changes of lipoproteins. J Infect Dis 181(Suppl 3): S462-S472 https://doi.org/10.1086/315611
  13. Kim Myung Sik, Ko Kyung Soo, Park Won Do (1996): Assessment of Parameters between Diabetic and Non-diabetic Patients Undergoing Maintenance Hemodialysis. The Korean Journal of Internal Medicine 51(4): 472-479
  14. Kopple JD, Massry SG (2004): Kopple and Massry's nutritional management or renal disease. 2nd edition. Lippincott Williams & Wilkins
  15. Lagrand WK, Niessen HW, Wolbink GJ, Jaspars LH, Visser CA, Verheugt FW, Meijer CJ, Hack CE (1997): C-reactive protein colocalizes with complement in human hearts during acute myocardial infarction. Circulation 95(1): 97-103 https://doi.org/10.1161/01.CIR.95.1.97
  16. Lee CH, Chang HW, Wang IK, Lin CL, Chen TC, Wang PH, Chang HY, Chen JB, Hsu KT, Chuang FR (2004): Diabetes mellitus, hyperhomocystinemia and atherosclerotic vascular disease in Taiwanese chronic hemodialysis patients: a retrospective study. Ren Fail 26(3): 317-323 https://doi.org/10.1081/JDI-200026741
  17. Locatelli F, Fouque D, Heimburger O, Drueke TB, Cannata-Andia JB, Horl WH, Ritz E (2002): Nutritional status in dialysis patients: a European consensus. Nephrol Dial Transplant 17(4): 563-572 https://doi.org/10.1093/ndt/17.4.563
  18. Locatelli F, Pisoni RL, Akizawa T, Cruz JM, DeOreo PB, Lameire NH, Held PJ (2004): Anemia management for hemodialysis patients: Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines and Dialysis Outcomes and Practice Patterns Study (DOPPS) findings. Am J Kidney Dis 44(5 Suppl 3): 27-33 https://doi.org/10.1016/S0272-6386(04)01102-3
  19. Marckmann P (1988): Nutritional status of patients on hemodialysis and peritoneal dialysis. Clin Nephrol 29(2): 75-78
  20. Nakao T, Matsumoto H, Okada T, Kanazawa Y, Yoshino M, Nagaoka Y, Takeguchi F (2003): Nutritional management of dialysis patients: balancing among nutrient intake, dialysis dose, and nutritional status. Am J Kidney Dis 41(3 Suppl 1): S133-136 https://doi.org/10.1053/ajkd.2003.50102
  21. National Kidney Foundation (2000): K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. Am J Kidney Dis 35 (suppl 2): S1-S104 https://doi.org/10.1016/S0272-6386(00)70294-0
  22. Park CW, Shin YS, Kim CM, Lee SY, Yu SE, Kim SY, Choi EJ, Chang YS, Bang BK (2002): Increased C-reactive protein following hemodialysis predicts cardiac hypertrophy in chronic hemodialysis patients. Am J Kidney Dis 40(6): 1230-1239 https://doi.org/10.1053/ajkd.2002.36891
  23. Park Jeong Sig, Kim Sun Bae (2004): Clinical Significance of C-reactive Protein in Patients with End-stage Renal Disease. The Korean Society of Nephrology 23(2): 185-187
  24. Pasceri V, Willerson JT, Yeh ET (2000): Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 102 (18): 2165-2168 https://doi.org/10.1161/01.CIR.102.18.2165
  25. Qureshi AR, Alvestrand A, Danielsson A, Divino-Filho JC, Gutierrez A, Lindholm B, Bergstrom J (1998): Factors predicting malnutrition in hemodialysis patients: a cross-sectional study. Kidney Int 53(3): 773-782 https://doi.org/10.1046/j.1523-1755.1998.00812.x
  26. Sethi D, Muller BR, Brown EA, Maini RN, Gower PE (1988): C-reactive protein in haemodialysis patients with dialysis arthropathy. Nephrol Dial Transplant 3(3): 269-271
  27. Slomowitz LA, Monteon FJ, Grosvenor M, Laidlaw SA, Kopple JD (1989): Effect of energy intake on nutritional status in maintenance hemodialysis patients. Kidney Int 35(2): 704-711 https://doi.org/10.1038/ki.1989.42
  28. Stenvinkel P, Heimburger O, Paultre F, Diczfalusy U, Wang T, Berglund L, Jogestrand T (1999): Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 55(5): 1899-1911 https://doi.org/10.1046/j.1523-1755.1999.00422.x
  29. Szczech LA, Reddan DN, Klassen PS, Coladonato J, Chua B, Lowrie EG, Lazarus JM, Owen WF Jr (2003): Interactions between dialysis- related volume exposures, nutritional surrogates and mortality among ESRD patients. Nephrol Dial Transplant 18(8): 1585-1591 https://doi.org/10.1093/ndt/gfg225
  30. Torzewski J, Torzewski M, Bowyer DE, Frohlich M, Koenig W, Waltenberger J, Fitzsimmons C, Hombach V (1998): C-reactive protein frequently colocalizes with the terminal complement complex in the intima of early atherosclerotic lesions of human coronary arteries. Arterioscler Thromb Vasc Biol 18(9): 1386-1392 https://doi.org/10.1161/01.ATV.18.9.1386