Background. Residual renal function (RRF) correlates with survival in peritoneal dialysis (PD). W... more Background. Residual renal function (RRF) correlates with survival in peritoneal dialysis (PD). We investigated the association between oxidative stress and RRF in PD. Methods. Adequacy of dialysis, total and free malondialdehydes (MDA), and lipid hydroperoxides (LHP) were obtained from 23 stable PD patients. Results. Free MDA level decreased with total weekly Kt/ V urea (r = −0.51, P = 0.013) and urinary Kt/V (KRU) (r = −0.53, P = 0.009), but not with peritoneal Kt/V. Similar results were found with LHP level. In multivariate analysis, total weekly Kt/V urea and KRU remained associated with free MDA and LHP, independently of gender, nutritional or inflammatory status, and peritoneal permeability. Conclusion. A preserved RRF is associated with lower serum levels of lipid peroxidation products among PD patients.
Observational studies from several groups have shown consistent beneficial effects in patients tr... more Observational studies from several groups have shown consistent beneficial effects in patients treated with short daily hemodialysis (SDHD). The cardiovascular and nutritional changes appear during the first few months after the initiation of SDHD. An extensive review of 17 patients from a group of 36 ESRD patients treated for up to 6 years with SDHD was undertaken to compare the clinicobiologic results during the initial period of standard hemodialysis (3 x 4 hr/week) and the short daily hemodialysis period at 1 year (SDHD(1)) and subsequent years (SDHD(2)). The statistical analysis of the clinicobiologic data clearly shows that the initial favorable results obtained during the first year of SDHD do persist in the mid and long term, which shows the more physiologic nature of this dialytic approach. The amelioration of left ventricular hypertrophy is of particular interest, showing a regression of ventricular dilation during the first year followed by a reduction of interventricular septum and posterior wall thickness during the subsequent years.
Accurate evaluation of oxidative stress is needed for patients on chronic hemodialysis (HD), as c... more Accurate evaluation of oxidative stress is needed for patients on chronic hemodialysis (HD), as cardiovascular risk level seems related to it. Oxidative stress is often evaluated by measuring an end product of lipoperoxidation named malondialdehyde (MDA). However, the most common technique for measuring MDA, the Thio Barbituric Acid Reactive Substances method (TBARS), is known to be sensitive but poorly specific. We measured true total and free plasma MDA in fifty-four unselected patients on long-term HD, before and after HD sessions, by a new, highly specific HPLC method. Total and free MDA were higher before than after dialysis. Essentially, free MDA was decreased by HD but its fractional decrease was lower than that of urea or creatinine. This confirms that, in fact, free MDA is more or less bound to low molecular weight compounds and/or suggests that MDA may be produced mainly during HD sessions. We propose this new tool to further explore the relationship between oxidative stre...
Undernutrition (UN) in chronic hemodialysis (CHD) is a recurrent complication and constitutes a m... more Undernutrition (UN) in chronic hemodialysis (CHD) is a recurrent complication and constitutes a major public health problem. This work aims to evaluate the effects of our nutritional strategy (NS) developed among malnourished patients (pts) in CHD. This is a prospective observational study conducted for 12 months (M) in a cohort of 132 pts in CHD including 49 women, mean age 66±16 years and the dialysis vintage 72±74 months. This NS is based on the action of a multidisciplinary team; it provides for moderate UN pts one first phase of an optimization of protein and energy intake in the daily meals; then depending on the clinical course a second phase of oral supplementation at home. For severe UN pts, the optimization of daily meals and the oral supplements at home are reinforced with perdialytic oral supplementation. This modality was also prescribed for moderate UN pts with poor compliance at home. In case of loss of appetite, anorexia, gastrointestinal intolerance or inadequate oral intakes the relay is made by the intradialytic parenteral nutrition (IPN). Methods consist in the evaluation of the serum albumin (ALB), CRP, normalized PCR (nPCR), and Kt/V ratio of urea at baseline (day (D) 0) and at endpoint (M12). The ALB was measured by immunoturbidimetry. Three nutritional profiles were defined, severe UN if ALB ≤35g/L, moderate UN if 35 <ALB <38g/L, no UN if ALB ≥38g/L. The therapeutic goal is to obtain a target ALB ≥38g/L, protein intake exceeding 1g/kg/d and energy intake exceeding 35 Kcal/kg/d. The criteria of effectiveness are obtaining the ALB defined target, changes in numbers of pts in 3 nutritional profiles and mortality rate on 1 year. We observe a significant improvement in all nutritional indicators at M12. The numbers of pts with severe UN and moderate UN decreased (P<0,05), respectively from 32 to 14% and from 27 to 18% (D0 versus M12). The UN frequency has been reduced about 50% (P<0,05) lowering from 59 to 32%. The mortality rate of 4% (5/132 pts) in 1 year was very low. The therapeutic goal is achieved under the conjunction of 3 essential conditions, the improvement of the inflammatory syndrome, an effective dialysis and optimal protein and caloric intake. At the start and the end of the study, the role of inflammation appears crucial because ALB is greater if CRP <10mg/L versus CRP ≥10mg/L (at M12: 40 versus 38g/L, P=0.002); an inverse correlation is observed between CRP and ALB (R(2)=0,080, P=0.002). An effective NS reduces the frequency of UN in CHD, improves the quality of life the pts and lowers mortality rates. An oral nutritional supplement during dialysis constitutes an important component of treatment. The control of inflammation and optimizing dialysis are decisive factors of success.
Accurate evaluation of oxidative stress is needed for patients on chronic hemodialysis (HD), as c... more Accurate evaluation of oxidative stress is needed for patients on chronic hemodialysis (HD), as cardiovascular risk level seems related to it. Oxidative stress is often evaluated by measuring an end product of lipoperoxidation named malondialdehyde (MDA). However, the most common technique for measuring MDA, the Thio Barbituric Acid Reactive Substances method (TBARS), is known to be sensitive but poorly specific.
Hyperparathyroïdie secondaire et ané mie. Effets d'un calcimimé tique sur le contrôle de l'ané mi... more Hyperparathyroïdie secondaire et ané mie. Effets d'un calcimimé tique sur le contrôle de l'ané mie des hé modialysé s chroniques. É tude pilote Secondary hyperparathyroidism and anemia. Effects of a calcimimetic on the control of anemia in chronic hemodialysed patients. Pilot Study a Association pour l'utilisation du rein artificiel dans la re´gion lyonnaise (Aural), 124, rue Villon,
Twenty-five years of experience with out-center hemodialysis.BackgroundOut-center hemodialysis (H... more Twenty-five years of experience with out-center hemodialysis.BackgroundOut-center hemodialysis (HD) offers patients a better quality of life, a greater independence, and a better rehabilitation opportunity. A lower mortality than with other modalities of dialysis has been reported. In addition, in France the charges paid depend on the modality of dialysis, out-center HD being the less expensive, and savings are also accomplished
The aim of this study was to compare clinical and biological results in 4 standard hemodialyzed p... more The aim of this study was to compare clinical and biological results in 4 standard hemodialyzed patients originally treated by three 4-5 h sessions per week and converted within one year to daily hemodialysis sessions of 2-2.5 h each 6 times per week. The modalities and the total weekly dialysis times remained the same. With daily hemodialysis, the blood pressure and left ventricular mass index decreased significantly (p < 0.01). A significant decrease in the urea time averaged deviation (TAD) (p < 0.005) and increase in the Kt/V index (p < 0.05) were observed. A gain in dry weight was shown with a rise in caloric intake from 33+/-3.21 to 40.8+/-6.35 kcal/kg/day (p < 0.05), and the normalized protein catabolic rate (nPCR) increased significantly (p < 0.0038). One patient who was receiving erythropoietin (EPO) for anemia could stop his treatment. No arteriovenous fistula complications were observed. Daily hemodialysis seems to be the method of choice to manage hypertension and left ventricular hypertrophy in uremic patients. The increase of the urea TAD to a value closer to that of the healthy kidney due to the increase of the frequency of dialysis is probably the main explanation for clinical improvement.
Objective: Compounds involved in the regulation of appetite and body composition appear to be of ... more Objective: Compounds involved in the regulation of appetite and body composition appear to be of interest in chronic kidney disease. The purpose of this study was to analyze plasma obestatin and acyl and des-acyl ghrelin in patients on hemodialysis (HD). Methods: Fifty patients on HD (56.0% women, mean age 62.2 AE 15.2 y) were studied. Blood samples were collected during fasting, before a regular HD session. Serum acyl and des-acyl ghrelin levels, leptin, and obestatin were measured using enzyme immunometric assay methods. Anthropometric parameters, appetite score, and food intake were recorded. Results: Patients showed elevated serum leptin (34.1 AE 30 ng/mL), normal acyl ghrelin (137 AE 116.5 pg/mL), high des-acyl ghrelin (670 AE 479 pg/mL), and low obestatin (2.0 AE 1.4 ng/mL) levels compared with healthy volunteers. According to body mass index (BMI), patients with a BMI >23 kg/m 2 had significantly lower plasma obestatin. In contrast, leptin levels were increased and acyl ghrelin tended to be higher in these patients. There was a strong positive correlation between obestatin and des-acyl ghrelin (r ¼ 0.56, P ¼ 0.0001) and inverse correlations between obestatin and BMI (r ¼ À0.40, P ¼ 0.007), waist circumference (r ¼ À0.38, P ¼ 0.024), and C-reactive protein (r ¼ À0.29, P ¼ 0.048). By multivariate analysis, obestatin was independently and positively correlated with des-acyl ghrelin (P ¼ 0.01), but not with C-reactive protein, BMI, or waist circumference. Conclusion: In summary, patients on HD exhibited increased plasma levels of des-acyl ghrelin, normal acyl ghrelin levels, and low obestatin levels. In lean patients, the obestatin and des-acyl ghrelin levels were increased, suggesting that these hormones may influence appetite and body composition in patients on HD.
Short daily hemodialysis rapidly improves nutritional status in been well described [2, 3]. Strat... more Short daily hemodialysis rapidly improves nutritional status in been well described [2, 3]. Strategies for preventing or hemodialysis patients.
The accurate estimation of total daily energy expenditure (TEE) in chronic kidney patients is ess... more The accurate estimation of total daily energy expenditure (TEE) in chronic kidney patients is essential to allow the provision of nutritional requirements; however, it remains a challenge to collect actual physical activity and resting energy expenditure in maintenance dialysis patients. The direct measurement of TEE by direct calorimetry or doubly labeled water cannot be used easily so that, in clinical practice, TEE is usually estimated from resting energy expenditure and physical activity. Prediction equations may also be used to estimate resting energy expenditure; however, their use has been poorly documented in dialysis patients. Recently, a new system called SenseWear Armband (BodyMedia, Pittsburgh, PA) was developed to assess TEE, but so far no data have been published in chronic kidney disease patients. The aim of this review is to describe new measurements of energy expenditure and physical activity in chronic kidney disease patients.
Background and Objectives: Studies show that inflammation can contribute to an increase in restin... more Background and Objectives: Studies show that inflammation can contribute to an increase in resting energy expenditure in patients with chronic kidney disease; however, findings about total energy expenditure (TEE) have not been reported. The aim of this study was to evaluate the effects of inflammation on TEE and physical activity energy expenditure in hemodialysis (HD) patients.
Observational studies from several groups have shown consistent beneficial effects in patients tr... more Observational studies from several groups have shown consistent beneficial effects in patients treated with short daily hemodialysis (SDHD). The cardiovascular and nutritional changes appear during the first few months after the initiation of SDHD. An extensive review of 17 patients from a group of 36 ESRD patients treated for up to 6 years with SDHD was undertaken to compare the clinicobiologic results during the initial period of standard hemodialysis (3 x 4 hr/week) and the short daily hemodialysis period at 1 year (SDHD(1)) and subsequent years (SDHD(2)). The statistical analysis of the clinicobiologic data clearly shows that the initial favorable results obtained during the first year of SDHD do persist in the mid and long term, which shows the more physiologic nature of this dialytic approach. The amelioration of left ventricular hypertrophy is of particular interest, showing a regression of ventricular dilation during the first year followed by a reduction of interventricular septum and posterior wall thickness during the subsequent years.
Leptin is a 16-kd protein that increases energy expenditure and limits food intake. Serum leptin ... more Leptin is a 16-kd protein that increases energy expenditure and limits food intake. Serum leptin (S-leptin) is elevated in dialysis patients, and little data have been reported on leptin clearance (Cl) during dialysis. We analyzed the peritoneal dialysis (PD) Cl of leptin in 15 continuous ambulatory peritoneal dialysis (CAPD) patients and compared the results to  2 -microglobulin ( 2 -m), urea, and creatinine PD Cl. S-leptin was significantly elevated (Kruskal-Wallis, P F 0.005) in CAPD women (58.4 ؎ 42.4 [SE] g/L, n ؍ 5) as compared with CAPD men (13.9 ؎ 7.1, n ؍ 10) and with healthy women (11.0 ؎ 1.4, n ؍ 13) and men (5.1 ؎ 0.9, n ؍ 14). Correlations were found between percent of fat mass and S-leptin (P F 0.05); between S-leptin and the 24-hour PD leptin (P F 0.05); and between dialysate-to-plasma (D/P)  2 -m and D/P leptin (P F 0.01). PD leptin Cl (1.80 ؎ 0.43 mL/min/1.73 m 2 ) was higher than  2 -m Cl (1.22 ؎ 0.31) (P F 0.01), but reduced as compared with urea Cl (8.84 ؎ 1.20) (P F 0.005) and creatinine Cl (7.71 ؎ 0.99) (P F 0.005). These results indicate that leptin is eliminated through the peritoneum membrane. However, peritoneal leptin clearance, as  2 -m, appears to be clearly restricted as compared with peritoneal transport of smaller molecules. Hence, leptin could use the same diffusion transport pathway as  2 -m. In addition, leptin, which has a higher molecular weight than  2 -m, was significantly more eliminated into the peritoneal dialysate. More studies are necessary to clarify whether this is an active leptin elimination process by peritoneal secretion or by a different restriction coefficient of diffusion through the peritoneum membrane. 1999 by the National Kidney Foundation, Inc. INDEX WORDS: Leptin;  2 -microglobulin; peritoneal clearance; continuous ambulatory peritoneal dialysis (CAPD).
Daily hemodialysis improves clinical outcomes in dialysis patients. This study shows the results ... more Daily hemodialysis improves clinical outcomes in dialysis patients. This study shows the results of 10 patients who underwent short daily hemodialysis (SDHD) from 23.2 ؎ 13 months and focuses on nutritional status under this strategy. With SDHD, patients had an increase in energy and protein intake confirmed by an increase in dry weight and lean body mass. Additional clinical improvement was obtained for blood pressure control, regression of left ventricular hypertrophy, correction of anemia, and better quality of life. These biological and clinical improvements are mainly the results of a higher frequency of dialysis sessions. The nutritional improvements with disappearance of anorexia are the consequence of general well being, less dietetic constraints, and less drugs prescribed. Short daily hemodialysis offers an adequate and more physiological strategy and may be considered for improving nutritional status in selected patients.
Background. Residual renal function (RRF) correlates with survival in peritoneal dialysis (PD). W... more Background. Residual renal function (RRF) correlates with survival in peritoneal dialysis (PD). We investigated the association between oxidative stress and RRF in PD. Methods. Adequacy of dialysis, total and free malondialdehydes (MDA), and lipid hydroperoxides (LHP) were obtained from 23 stable PD patients. Results. Free MDA level decreased with total weekly Kt/ V urea (r = −0.51, P = 0.013) and urinary Kt/V (KRU) (r = −0.53, P = 0.009), but not with peritoneal Kt/V. Similar results were found with LHP level. In multivariate analysis, total weekly Kt/V urea and KRU remained associated with free MDA and LHP, independently of gender, nutritional or inflammatory status, and peritoneal permeability. Conclusion. A preserved RRF is associated with lower serum levels of lipid peroxidation products among PD patients.
Observational studies from several groups have shown consistent beneficial effects in patients tr... more Observational studies from several groups have shown consistent beneficial effects in patients treated with short daily hemodialysis (SDHD). The cardiovascular and nutritional changes appear during the first few months after the initiation of SDHD. An extensive review of 17 patients from a group of 36 ESRD patients treated for up to 6 years with SDHD was undertaken to compare the clinicobiologic results during the initial period of standard hemodialysis (3 x 4 hr/week) and the short daily hemodialysis period at 1 year (SDHD(1)) and subsequent years (SDHD(2)). The statistical analysis of the clinicobiologic data clearly shows that the initial favorable results obtained during the first year of SDHD do persist in the mid and long term, which shows the more physiologic nature of this dialytic approach. The amelioration of left ventricular hypertrophy is of particular interest, showing a regression of ventricular dilation during the first year followed by a reduction of interventricular septum and posterior wall thickness during the subsequent years.
Accurate evaluation of oxidative stress is needed for patients on chronic hemodialysis (HD), as c... more Accurate evaluation of oxidative stress is needed for patients on chronic hemodialysis (HD), as cardiovascular risk level seems related to it. Oxidative stress is often evaluated by measuring an end product of lipoperoxidation named malondialdehyde (MDA). However, the most common technique for measuring MDA, the Thio Barbituric Acid Reactive Substances method (TBARS), is known to be sensitive but poorly specific. We measured true total and free plasma MDA in fifty-four unselected patients on long-term HD, before and after HD sessions, by a new, highly specific HPLC method. Total and free MDA were higher before than after dialysis. Essentially, free MDA was decreased by HD but its fractional decrease was lower than that of urea or creatinine. This confirms that, in fact, free MDA is more or less bound to low molecular weight compounds and/or suggests that MDA may be produced mainly during HD sessions. We propose this new tool to further explore the relationship between oxidative stre...
Undernutrition (UN) in chronic hemodialysis (CHD) is a recurrent complication and constitutes a m... more Undernutrition (UN) in chronic hemodialysis (CHD) is a recurrent complication and constitutes a major public health problem. This work aims to evaluate the effects of our nutritional strategy (NS) developed among malnourished patients (pts) in CHD. This is a prospective observational study conducted for 12 months (M) in a cohort of 132 pts in CHD including 49 women, mean age 66±16 years and the dialysis vintage 72±74 months. This NS is based on the action of a multidisciplinary team; it provides for moderate UN pts one first phase of an optimization of protein and energy intake in the daily meals; then depending on the clinical course a second phase of oral supplementation at home. For severe UN pts, the optimization of daily meals and the oral supplements at home are reinforced with perdialytic oral supplementation. This modality was also prescribed for moderate UN pts with poor compliance at home. In case of loss of appetite, anorexia, gastrointestinal intolerance or inadequate oral intakes the relay is made by the intradialytic parenteral nutrition (IPN). Methods consist in the evaluation of the serum albumin (ALB), CRP, normalized PCR (nPCR), and Kt/V ratio of urea at baseline (day (D) 0) and at endpoint (M12). The ALB was measured by immunoturbidimetry. Three nutritional profiles were defined, severe UN if ALB ≤35g/L, moderate UN if 35 <ALB <38g/L, no UN if ALB ≥38g/L. The therapeutic goal is to obtain a target ALB ≥38g/L, protein intake exceeding 1g/kg/d and energy intake exceeding 35 Kcal/kg/d. The criteria of effectiveness are obtaining the ALB defined target, changes in numbers of pts in 3 nutritional profiles and mortality rate on 1 year. We observe a significant improvement in all nutritional indicators at M12. The numbers of pts with severe UN and moderate UN decreased (P<0,05), respectively from 32 to 14% and from 27 to 18% (D0 versus M12). The UN frequency has been reduced about 50% (P<0,05) lowering from 59 to 32%. The mortality rate of 4% (5/132 pts) in 1 year was very low. The therapeutic goal is achieved under the conjunction of 3 essential conditions, the improvement of the inflammatory syndrome, an effective dialysis and optimal protein and caloric intake. At the start and the end of the study, the role of inflammation appears crucial because ALB is greater if CRP <10mg/L versus CRP ≥10mg/L (at M12: 40 versus 38g/L, P=0.002); an inverse correlation is observed between CRP and ALB (R(2)=0,080, P=0.002). An effective NS reduces the frequency of UN in CHD, improves the quality of life the pts and lowers mortality rates. An oral nutritional supplement during dialysis constitutes an important component of treatment. The control of inflammation and optimizing dialysis are decisive factors of success.
Accurate evaluation of oxidative stress is needed for patients on chronic hemodialysis (HD), as c... more Accurate evaluation of oxidative stress is needed for patients on chronic hemodialysis (HD), as cardiovascular risk level seems related to it. Oxidative stress is often evaluated by measuring an end product of lipoperoxidation named malondialdehyde (MDA). However, the most common technique for measuring MDA, the Thio Barbituric Acid Reactive Substances method (TBARS), is known to be sensitive but poorly specific.
Hyperparathyroïdie secondaire et ané mie. Effets d'un calcimimé tique sur le contrôle de l'ané mi... more Hyperparathyroïdie secondaire et ané mie. Effets d'un calcimimé tique sur le contrôle de l'ané mie des hé modialysé s chroniques. É tude pilote Secondary hyperparathyroidism and anemia. Effects of a calcimimetic on the control of anemia in chronic hemodialysed patients. Pilot Study a Association pour l'utilisation du rein artificiel dans la re´gion lyonnaise (Aural), 124, rue Villon,
Twenty-five years of experience with out-center hemodialysis.BackgroundOut-center hemodialysis (H... more Twenty-five years of experience with out-center hemodialysis.BackgroundOut-center hemodialysis (HD) offers patients a better quality of life, a greater independence, and a better rehabilitation opportunity. A lower mortality than with other modalities of dialysis has been reported. In addition, in France the charges paid depend on the modality of dialysis, out-center HD being the less expensive, and savings are also accomplished
The aim of this study was to compare clinical and biological results in 4 standard hemodialyzed p... more The aim of this study was to compare clinical and biological results in 4 standard hemodialyzed patients originally treated by three 4-5 h sessions per week and converted within one year to daily hemodialysis sessions of 2-2.5 h each 6 times per week. The modalities and the total weekly dialysis times remained the same. With daily hemodialysis, the blood pressure and left ventricular mass index decreased significantly (p < 0.01). A significant decrease in the urea time averaged deviation (TAD) (p < 0.005) and increase in the Kt/V index (p < 0.05) were observed. A gain in dry weight was shown with a rise in caloric intake from 33+/-3.21 to 40.8+/-6.35 kcal/kg/day (p < 0.05), and the normalized protein catabolic rate (nPCR) increased significantly (p < 0.0038). One patient who was receiving erythropoietin (EPO) for anemia could stop his treatment. No arteriovenous fistula complications were observed. Daily hemodialysis seems to be the method of choice to manage hypertension and left ventricular hypertrophy in uremic patients. The increase of the urea TAD to a value closer to that of the healthy kidney due to the increase of the frequency of dialysis is probably the main explanation for clinical improvement.
Objective: Compounds involved in the regulation of appetite and body composition appear to be of ... more Objective: Compounds involved in the regulation of appetite and body composition appear to be of interest in chronic kidney disease. The purpose of this study was to analyze plasma obestatin and acyl and des-acyl ghrelin in patients on hemodialysis (HD). Methods: Fifty patients on HD (56.0% women, mean age 62.2 AE 15.2 y) were studied. Blood samples were collected during fasting, before a regular HD session. Serum acyl and des-acyl ghrelin levels, leptin, and obestatin were measured using enzyme immunometric assay methods. Anthropometric parameters, appetite score, and food intake were recorded. Results: Patients showed elevated serum leptin (34.1 AE 30 ng/mL), normal acyl ghrelin (137 AE 116.5 pg/mL), high des-acyl ghrelin (670 AE 479 pg/mL), and low obestatin (2.0 AE 1.4 ng/mL) levels compared with healthy volunteers. According to body mass index (BMI), patients with a BMI >23 kg/m 2 had significantly lower plasma obestatin. In contrast, leptin levels were increased and acyl ghrelin tended to be higher in these patients. There was a strong positive correlation between obestatin and des-acyl ghrelin (r ¼ 0.56, P ¼ 0.0001) and inverse correlations between obestatin and BMI (r ¼ À0.40, P ¼ 0.007), waist circumference (r ¼ À0.38, P ¼ 0.024), and C-reactive protein (r ¼ À0.29, P ¼ 0.048). By multivariate analysis, obestatin was independently and positively correlated with des-acyl ghrelin (P ¼ 0.01), but not with C-reactive protein, BMI, or waist circumference. Conclusion: In summary, patients on HD exhibited increased plasma levels of des-acyl ghrelin, normal acyl ghrelin levels, and low obestatin levels. In lean patients, the obestatin and des-acyl ghrelin levels were increased, suggesting that these hormones may influence appetite and body composition in patients on HD.
Short daily hemodialysis rapidly improves nutritional status in been well described [2, 3]. Strat... more Short daily hemodialysis rapidly improves nutritional status in been well described [2, 3]. Strategies for preventing or hemodialysis patients.
The accurate estimation of total daily energy expenditure (TEE) in chronic kidney patients is ess... more The accurate estimation of total daily energy expenditure (TEE) in chronic kidney patients is essential to allow the provision of nutritional requirements; however, it remains a challenge to collect actual physical activity and resting energy expenditure in maintenance dialysis patients. The direct measurement of TEE by direct calorimetry or doubly labeled water cannot be used easily so that, in clinical practice, TEE is usually estimated from resting energy expenditure and physical activity. Prediction equations may also be used to estimate resting energy expenditure; however, their use has been poorly documented in dialysis patients. Recently, a new system called SenseWear Armband (BodyMedia, Pittsburgh, PA) was developed to assess TEE, but so far no data have been published in chronic kidney disease patients. The aim of this review is to describe new measurements of energy expenditure and physical activity in chronic kidney disease patients.
Background and Objectives: Studies show that inflammation can contribute to an increase in restin... more Background and Objectives: Studies show that inflammation can contribute to an increase in resting energy expenditure in patients with chronic kidney disease; however, findings about total energy expenditure (TEE) have not been reported. The aim of this study was to evaluate the effects of inflammation on TEE and physical activity energy expenditure in hemodialysis (HD) patients.
Observational studies from several groups have shown consistent beneficial effects in patients tr... more Observational studies from several groups have shown consistent beneficial effects in patients treated with short daily hemodialysis (SDHD). The cardiovascular and nutritional changes appear during the first few months after the initiation of SDHD. An extensive review of 17 patients from a group of 36 ESRD patients treated for up to 6 years with SDHD was undertaken to compare the clinicobiologic results during the initial period of standard hemodialysis (3 x 4 hr/week) and the short daily hemodialysis period at 1 year (SDHD(1)) and subsequent years (SDHD(2)). The statistical analysis of the clinicobiologic data clearly shows that the initial favorable results obtained during the first year of SDHD do persist in the mid and long term, which shows the more physiologic nature of this dialytic approach. The amelioration of left ventricular hypertrophy is of particular interest, showing a regression of ventricular dilation during the first year followed by a reduction of interventricular septum and posterior wall thickness during the subsequent years.
Leptin is a 16-kd protein that increases energy expenditure and limits food intake. Serum leptin ... more Leptin is a 16-kd protein that increases energy expenditure and limits food intake. Serum leptin (S-leptin) is elevated in dialysis patients, and little data have been reported on leptin clearance (Cl) during dialysis. We analyzed the peritoneal dialysis (PD) Cl of leptin in 15 continuous ambulatory peritoneal dialysis (CAPD) patients and compared the results to  2 -microglobulin ( 2 -m), urea, and creatinine PD Cl. S-leptin was significantly elevated (Kruskal-Wallis, P F 0.005) in CAPD women (58.4 ؎ 42.4 [SE] g/L, n ؍ 5) as compared with CAPD men (13.9 ؎ 7.1, n ؍ 10) and with healthy women (11.0 ؎ 1.4, n ؍ 13) and men (5.1 ؎ 0.9, n ؍ 14). Correlations were found between percent of fat mass and S-leptin (P F 0.05); between S-leptin and the 24-hour PD leptin (P F 0.05); and between dialysate-to-plasma (D/P)  2 -m and D/P leptin (P F 0.01). PD leptin Cl (1.80 ؎ 0.43 mL/min/1.73 m 2 ) was higher than  2 -m Cl (1.22 ؎ 0.31) (P F 0.01), but reduced as compared with urea Cl (8.84 ؎ 1.20) (P F 0.005) and creatinine Cl (7.71 ؎ 0.99) (P F 0.005). These results indicate that leptin is eliminated through the peritoneum membrane. However, peritoneal leptin clearance, as  2 -m, appears to be clearly restricted as compared with peritoneal transport of smaller molecules. Hence, leptin could use the same diffusion transport pathway as  2 -m. In addition, leptin, which has a higher molecular weight than  2 -m, was significantly more eliminated into the peritoneal dialysate. More studies are necessary to clarify whether this is an active leptin elimination process by peritoneal secretion or by a different restriction coefficient of diffusion through the peritoneum membrane. 1999 by the National Kidney Foundation, Inc. INDEX WORDS: Leptin;  2 -microglobulin; peritoneal clearance; continuous ambulatory peritoneal dialysis (CAPD).
Daily hemodialysis improves clinical outcomes in dialysis patients. This study shows the results ... more Daily hemodialysis improves clinical outcomes in dialysis patients. This study shows the results of 10 patients who underwent short daily hemodialysis (SDHD) from 23.2 ؎ 13 months and focuses on nutritional status under this strategy. With SDHD, patients had an increase in energy and protein intake confirmed by an increase in dry weight and lean body mass. Additional clinical improvement was obtained for blood pressure control, regression of left ventricular hypertrophy, correction of anemia, and better quality of life. These biological and clinical improvements are mainly the results of a higher frequency of dialysis sessions. The nutritional improvements with disappearance of anorexia are the consequence of general well being, less dietetic constraints, and less drugs prescribed. Short daily hemodialysis offers an adequate and more physiological strategy and may be considered for improving nutritional status in selected patients.
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