The effect of hemodialysis, peritoneal dialysis and renal transplantation on nutritional status and serum micronutrient levels in patients with end-stage renal disease; Multicenter, 6-month period, longitudinal study⋆
Introduction
Malnutrition is very common among end stage renal disease (ESRD) patients [1]. It is known that malnutrition increases morbidity and mortality; possibly due to the specific micronutrient deficiencies [2,3]. Therefore, the micronutrients serum levels is of extreme importance in assessing the nutritional status and providing optimal management among ESRD patients and patients receiving renal replacement therapy (RRT).
Studies have suggested that variations of RRT such as hemodialysis, peritoneal dialysis (PD) and renal transplantation (RT) are associated with different clinical outcomes [4]. RT is the preferred treatment for most patients with ESRD, in terms of quality of life and survival rate [5]. In current studies, RT has not been compared in terms of nutritional status with other types of RRT. Malnutrition is one of the main complications in the late post- transplant period in which adequate nutritional status and plasma micronutrients may improve the outcomes [6]. Little research has been done to evaluate the influence of immunosuppressive drugs on the concentrations of plasma micronutrients in RT patients.
Micronutrient deficiencies in patients receiving RRT may be caused by poor food intake, intestinal dysfunction, inflammation, dialysate/ urine losses and abnormal metabolism [7]. Micronutrient levels may vary according to demographic region and traditional nutritional practices. At this point, it can be assumed that the 3 different types of RRT will not have a similar effect on micronutrient levels and nutritional status. However, at this time it is not known whether or not PD, hemodialysis or RT will have an enhancing or reducing effect on micronutrient levels. The present study aims to compare the effects of hemodialysis, PD and RT on the different micronutrient levels and nutritional status in patients with ESRD.
Section snippets
Design and participants
This prospective observational multi-center study took place from November 2015 to May 2017 at three different territorial care hospitals. The study was performed in accordance with the Helsinki Declaration and was approved by local ethics committee (Ethics Committee approval code: 2015/168). Written informed consent was obtained from all patients.
Adult ESRD patients who did not receive RRT, but were planning on starting one of the three types of RRT were included in the study. The plan was to
Results
A total of 77 ESRD patients (43 men and 34 women) participated in the study. Thirty of these patients underwent RT, 30 patients underwent hemodialysis and 17 patients underwent PD. The main causes of ESRD were hypertensive nephropathy (27 patients) and diabetic nephropathy (19 patients). The mean age of the study population was 52 ± 16.3. RT patients were significantly younger than hemodialysis patients (p < 0.001). The duration of ESRD was similar among the groups. The clinical and demographic
Discussion
The present study showed that the nutritional status and micronutrient levels of ESRD patients varied depending on the type of RRT and RT had some advantages compared to other types of RRT. The main limitation of micronutrient studies in dialysis patients is that they base conclusions on a single sample of anthropometric and biochemical parameters with no previous results prior to the start of RRT. Therefore, this study is the first that objectively demonstrates the effects of RRT on
Conclusion
We showed that performing a detailed nutritional assessment in ESRD patients to detect not only malnutrition but also micronutrient deficiency is of extreme importance. Our results support the recommendation that ESRD patients should be supplemented with mostly water soluble vitamins, especially thiamine and vitamin B6, and minerals such as zinc. The present investigation indicates that hemodialysis, PD and RT leads to different changes in the levels of micronutrients and other nutritional
Funding
This study was supported by TUBITAK (The Scientific and Technological Research Council of Turkey, Grant Number: 115S901). The funding source had no role in the design or the results obtained from the study.
Transparency document
CRediT authorship contribution statement
Oguzhan Sıtkı Dizdar: Conceptualization, Methodology, Writing - original draft. Abdulmecit Yıldız: Investigation, Resources. Cuma Bulent Gul: Visualization, Investigation. Ali Ihsan Gunal: Supervision. Alparslan Ersoy: Formal analysis, Validation. Kursat Gundogan: Methodology, Writing - review & editing.
Declaration of Competing Interest
The authors declare that they have no conflicts of interest.
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This study was presented as an oral presentation at 40th European Society of Parenteral Enteral Nutrition (ESPEN) congress in Madrid, SPAIN.