Protein-energy wasting of maintenance hemodialysis patients_West China Medical Journal

Authors：

ZHANG Xueqin , YANG Shufen , SONG Xue ,  LU Chen

Department of Nephrology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830001, P. R. China;

Corresponding author：

LU Chen, Email: luchen706812@163.com

Keywords：

Maintenance hemodialysis; Protein-energy wasting; Evaluation; Treatment

DOI：

10.7507/1002-0179.202006089

Video：

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Protein-energy wasting is one of the common complications of maintenance hemodialysis patients. It often causes decreased immune function, increased anemia, and decreased heart, brain, lung and other organ functions, resulting in decreased quality of life, decreased long-term survival rate, and increased mortality. This article discusses the causes, diagnosis, evaluation methods, intervention and prevention of protein-energy wasting in maintenance hemodialysis patients, and aims to provide a theoretical basis for evaluating the nutritional status, early intervention for protein-energy wasting, and improving prognosis and quality of life of maintenance hemodialysis patients.

Citation： ZHANG Xueqin, YANG Shufen, SONG Xue, LU Chen. Protein-energy wasting of maintenance hemodialysis patients. West China Medical Journal, 2020, 35(7): 868-872. doi: 10.7507/1002-0179.202006089 Copy

1.	Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int, 2008, 73(4): 391-398.
2.	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
3.	Bitker L, Bayle F, Yonis H, et al. Prevalence and risk factors of hypotension associated with preload-dependence during intermittent hemodialysis in critically ill patients. Crit Care, 2016, 20: 44.
4.	吴朦朦. 慢性肾脏病患者蛋白质能量消耗病因及诊治研究进展. 中华实用诊断与治疗杂志, 2017, 31(5): 514-517.
5.	Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis, 1990, 15(5): 458-482.
6.	袁伟杰, 叶志斌, 金惠敏. 肾脏病营养治疗学. 北京: 中国医药科技出版社, 2000: 327-329.
7.	Kalantar-Zadeh K, Kilpatrick RD, Kuwae N, et al. Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and population-attributable fraction. Nephrol Dial Transplant, 2005, 20(9): 1880-1888.
8.	Kalantar-Zadeh K, Kuwae N, Wu DY, et al. Associations of body fat and its changes over time with quality of life and prospective mortality in hemodialysis patients. Am J Clin Nutr, 2006, 83(2): 202-210.
9.	Noori N, Kopple JD, Kovesdy CP, et al. Mid-arm muscle circumference and quality of life and survival in maintenance hemodialysis patients. Clin J Am Soc Nephrol, 2010, 5(12): 2258-2268.
10.	Chang TI, Ngo V, Streja E, et al. Association of body weight changes with mortality in incident hemodialysis patients. Nephrol Dial Transplant, 2017, 32(9): 1549-1558.
11.	Ku E, Kopple JD, Johansen KL, et al. Longitudinal weight change during CKD progression and its association with subsequent mortality. Am J Kidney Dis, 2018, 71(5): 657-665.
12.	Carrero JJ, Johansen KL, Lindholm B, et al. Screening for muscle wasting and dysfunction in patients with chronic kidney disease. Kidney Int, 2016, 90(1): 53-66.
13.	Marcelli D, Usvyat LA, Kotanko P, et al. Body composition and survival in dialysis patients: results from an international cohort study. Clin J Am Soc Nephrol, 2015, 10(7): 1192-1200.
14.	Jerin L, Ladavac R, Kuzmanović G, et al. Subjective general assessment of nutritional status in patients with chronic renal failure and regular hemodialysis. Acta Med Croatica, 2003, 57(1): 23-28.
15.	Santin FG, Bigogno FG, Dias Rodrigues JC, et al. Concurrent and predictive validity of composite methods to assess nutritional status in older adults on hemodialysis. J Ren Nutr, 2016, 26(1): 18-25.
16.	黄莹. 慢性肾病营养不良患者的精细化营养管理. 实用临床医药杂志, 2020, 24(4): 77-80.
17.	周长菊, 曹娟, 章旭, 等. 维持性透析患者的蛋白能量消耗情况及影响因素分析. 中国血液净化, 2016, 15(9): 483-487.
18.	Kalantar-Zadeh K, Kopple JD, Block G, et al. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis, 2001, 38(6): 1251-1263.
19.	李丹丹, 刘桂凌. 营养不良-炎症评分评估腹膜透析患者营养状态及相关影响因素. 临床肾脏病杂志, 2016, 16(8): 482-486.
20.	Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4): 415-421.
21.	梁丹华, 谭荣韶, 刘岩, 等. 三种营养筛查工具对维持性血液透析病人透析相关性蛋白质-能量消耗的评价比较. 肠外与肠内营养, 2017, 24(3): 138-142.
22.	Führ LM, Wazlawik E, Garcia MF. The predictive value of composite methods of nutritional assessment on mortality among haemodialysis patients. Clin Nutr ESPEN, 2015, 10(1): e21-e25.
23.	Cano N, Fiaccadori E, Tesinsky P, et al. ESPEN guidelines on enteral nutrition: adult renal failure. Clin Nutr, 2006, 25(2): 295-310.
24.	Jo IY, Kim WJ, Park HC, et al. Effect of personalized nutritional counseling on the nutritional status of hemodialysis patients. Clin Nutr Res, 2017, 6(4): 285-295.
25.	Rocco MV, Paranandi L, Burrowes JD, et al. Nutritional status in the HEMO study cohort at baseline. Hemodialysis. Am J Kidney Dis, 2002, 39(2): 245-256.
26.	陈爱珍, 李静, 孙秀丽, 等. 血液透析途中高蛋白饮食对患者营养指标的影响. 中国血液净化, 2019, 18(12): 813-817.
27.	Fouque D, Vennegoor M, ter Wee P, et al. EBPG guideline on nutrition. Nephrol Dial Transplant, 2007, 22(Suppl 2): ii45-ii87.
28.	Kloppenburg WD, Stegeman CA, Hovinga TK, et al. Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients:a randomized, controlled trial. Nephrol Dial Transplant, 2004, 19(5): 1212-1223.
29.	Fouque D, Guebre-Egziabher F. An update on nutrition in chronic kidney disease. Int Urol Nephrol, 2007, 39(1): 239-246.
30.	Marsen TA, Beer J, Mann H, et al. Intradialytic parenteral nutrition in maintenance hemodialysis patients suffering from protein-energy wasting. Results of a multicenter, open, prospective, randomized trial. Clin Nutr, 2017, 36(1): 107-117.
31.	Thabet AF, Moeen SM, Labiqe MO, et al. Could intradialytic nutrition improve refractory anaemia in patients undergoing haemodialysis?. J Ren Care, 2017, 43(3): 183-191.
32.	韦翠美, 何永成, 李彤. 他汀类药物与肾脏之间的双重关系. 中国中西医结合肾病杂志, 2017, 18(9): 833-834.
33.	中国医师协会肾脏病医师分会血液透析充分性协作组. 中国血液透析充分性临床实践指南. 中华医学杂志, 2015, 95(34): 2748-2753.
34.	陈忠英, 范媛敏, 王清俊, 等. 维持性血液透析患者营养不良的临床治疗. 临床医学研究与实践, 2018, 3(29): 32-33.
35.	Pupim LB, Majchrzak KM, Flakoll PJ, et al. Intradialytic oral nutrition improves protein homeostasis in chronic hemodialysis patients with deranged nutritional status. J Am Soc Nephrol, 2006, 17(11): 3149-3157.
36.	Bolasco P, Cupisti A, Locatelli F, et al. Dietary management of incremental transition to dialysis therapy: once-weekly hemodialysis combined with low-protein diet. J Ren Nutr, 2016, 26(6): 352-359.
37.	Sabatino A, Regolisti G, Antonucci E, et al. Intradialytic parenteral nutrition in end-stage renal disease: practical aspects, indications and limits. J Nephrol, 2014, 27(4): 377-383.
38.	Cano NJ, Fouque D, Roth H, et al. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol, 2007, 18(9): 2583-2591.
39.	Jankowska M, Cobo G, Lindholm B, et al. Inflammation and protein-energy wasting in the Uremic Milieu. Contrib Nephrol, 2017, 191: 58-71.
40.	Asemi Z, Soleimani A, Shakeri H, et al. Effects of omega-3 fatty acid plus alpha-tocopherol supplementation on malnutrition-inflammation score, biomarkers of inflammation and oxidative stress in chronic hemodialysis patients. Int Urol Nephrol, 2016, 48(11): 1887-1895.
41.	张兰, 程艳娇, 赵新菊, 等. 卧位体操对维持性血液透析患者毒素清除和炎症状态影响的研究. 中国血液净化, 2017, 16(4): 247-250.
42.	易建伟, 何志红, 袁峰. 阿司匹林肠溶片对维持性血液透析患者炎症因子的影响. 江西医药, 2018, 53(7): 722-724.
43.	易晔, 卢远航, 冀倩倩. 高通量血液透析对糖尿病肾病透析患者氧化应激及微炎症状态的影响. 重庆医学, 2015, 44(19): 2667-2669.
44.	曹宁. 肾功能衰竭患者采用不同血液透析膜材料的生物相容性对比分析. 中国组织工程研究, 2012, 16(25): 4727-4734.

1. Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int, 2008, 73(4): 391-398.
2. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
3. Bitker L, Bayle F, Yonis H, et al. Prevalence and risk factors of hypotension associated with preload-dependence during intermittent hemodialysis in critically ill patients. Crit Care, 2016, 20: 44.
4. 吴朦朦. 慢性肾脏病患者蛋白质能量消耗病因及诊治研究进展. 中华实用诊断与治疗杂志, 2017, 31(5): 514-517.
5. Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis, 1990, 15(5): 458-482.
6. 袁伟杰, 叶志斌, 金惠敏. 肾脏病营养治疗学. 北京: 中国医药科技出版社, 2000: 327-329.
7. Kalantar-Zadeh K, Kilpatrick RD, Kuwae N, et al. Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and population-attributable fraction. Nephrol Dial Transplant, 2005, 20(9): 1880-1888.
8. Kalantar-Zadeh K, Kuwae N, Wu DY, et al. Associations of body fat and its changes over time with quality of life and prospective mortality in hemodialysis patients. Am J Clin Nutr, 2006, 83(2): 202-210.
9. Noori N, Kopple JD, Kovesdy CP, et al. Mid-arm muscle circumference and quality of life and survival in maintenance hemodialysis patients. Clin J Am Soc Nephrol, 2010, 5(12): 2258-2268.
10. Chang TI, Ngo V, Streja E, et al. Association of body weight changes with mortality in incident hemodialysis patients. Nephrol Dial Transplant, 2017, 32(9): 1549-1558.
11. Ku E, Kopple JD, Johansen KL, et al. Longitudinal weight change during CKD progression and its association with subsequent mortality. Am J Kidney Dis, 2018, 71(5): 657-665.
12. Carrero JJ, Johansen KL, Lindholm B, et al. Screening for muscle wasting and dysfunction in patients with chronic kidney disease. Kidney Int, 2016, 90(1): 53-66.
13. Marcelli D, Usvyat LA, Kotanko P, et al. Body composition and survival in dialysis patients: results from an international cohort study. Clin J Am Soc Nephrol, 2015, 10(7): 1192-1200.
14. Jerin L, Ladavac R, Kuzmanović G, et al. Subjective general assessment of nutritional status in patients with chronic renal failure and regular hemodialysis. Acta Med Croatica, 2003, 57(1): 23-28.
15. Santin FG, Bigogno FG, Dias Rodrigues JC, et al. Concurrent and predictive validity of composite methods to assess nutritional status in older adults on hemodialysis. J Ren Nutr, 2016, 26(1): 18-25.
16. 黄莹. 慢性肾病营养不良患者的精细化营养管理. 实用临床医药杂志, 2020, 24(4): 77-80.
17. 周长菊, 曹娟, 章旭, 等. 维持性透析患者的蛋白能量消耗情况及影响因素分析. 中国血液净化, 2016, 15(9): 483-487.
18. Kalantar-Zadeh K, Kopple JD, Block G, et al. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis, 2001, 38(6): 1251-1263.
19. 李丹丹, 刘桂凌. 营养不良-炎症评分评估腹膜透析患者营养状态及相关影响因素. 临床肾脏病杂志, 2016, 16(8): 482-486.
20. Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4): 415-421.
21. 梁丹华, 谭荣韶, 刘岩, 等. 三种营养筛查工具对维持性血液透析病人透析相关性蛋白质-能量消耗的评价比较. 肠外与肠内营养, 2017, 24(3): 138-142.
22. Führ LM, Wazlawik E, Garcia MF. The predictive value of composite methods of nutritional assessment on mortality among haemodialysis patients. Clin Nutr ESPEN, 2015, 10(1): e21-e25.
23. Cano N, Fiaccadori E, Tesinsky P, et al. ESPEN guidelines on enteral nutrition: adult renal failure. Clin Nutr, 2006, 25(2): 295-310.
24. Jo IY, Kim WJ, Park HC, et al. Effect of personalized nutritional counseling on the nutritional status of hemodialysis patients. Clin Nutr Res, 2017, 6(4): 285-295.
25. Rocco MV, Paranandi L, Burrowes JD, et al. Nutritional status in the HEMO study cohort at baseline. Hemodialysis. Am J Kidney Dis, 2002, 39(2): 245-256.
26. 陈爱珍, 李静, 孙秀丽, 等. 血液透析途中高蛋白饮食对患者营养指标的影响. 中国血液净化, 2019, 18(12): 813-817.
27. Fouque D, Vennegoor M, ter Wee P, et al. EBPG guideline on nutrition. Nephrol Dial Transplant, 2007, 22(Suppl 2): ii45-ii87.
28. Kloppenburg WD, Stegeman CA, Hovinga TK, et al. Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients:a randomized, controlled trial. Nephrol Dial Transplant, 2004, 19(5): 1212-1223.
29. Fouque D, Guebre-Egziabher F. An update on nutrition in chronic kidney disease. Int Urol Nephrol, 2007, 39(1): 239-246.
30. Marsen TA, Beer J, Mann H, et al. Intradialytic parenteral nutrition in maintenance hemodialysis patients suffering from protein-energy wasting. Results of a multicenter, open, prospective, randomized trial. Clin Nutr, 2017, 36(1): 107-117.
31. Thabet AF, Moeen SM, Labiqe MO, et al. Could intradialytic nutrition improve refractory anaemia in patients undergoing haemodialysis?. J Ren Care, 2017, 43(3): 183-191.
32. 韦翠美, 何永成, 李彤. 他汀类药物与肾脏之间的双重关系. 中国中西医结合肾病杂志, 2017, 18(9): 833-834.
33. 中国医师协会肾脏病医师分会血液透析充分性协作组. 中国血液透析充分性临床实践指南. 中华医学杂志, 2015, 95(34): 2748-2753.
34. 陈忠英, 范媛敏, 王清俊, 等. 维持性血液透析患者营养不良的临床治疗. 临床医学研究与实践, 2018, 3(29): 32-33.
35. Pupim LB, Majchrzak KM, Flakoll PJ, et al. Intradialytic oral nutrition improves protein homeostasis in chronic hemodialysis patients with deranged nutritional status. J Am Soc Nephrol, 2006, 17(11): 3149-3157.
36. Bolasco P, Cupisti A, Locatelli F, et al. Dietary management of incremental transition to dialysis therapy: once-weekly hemodialysis combined with low-protein diet. J Ren Nutr, 2016, 26(6): 352-359.
37. Sabatino A, Regolisti G, Antonucci E, et al. Intradialytic parenteral nutrition in end-stage renal disease: practical aspects, indications and limits. J Nephrol, 2014, 27(4): 377-383.
38. Cano NJ, Fouque D, Roth H, et al. Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol, 2007, 18(9): 2583-2591.
39. Jankowska M, Cobo G, Lindholm B, et al. Inflammation and protein-energy wasting in the Uremic Milieu. Contrib Nephrol, 2017, 191: 58-71.
40. Asemi Z, Soleimani A, Shakeri H, et al. Effects of omega-3 fatty acid plus alpha-tocopherol supplementation on malnutrition-inflammation score, biomarkers of inflammation and oxidative stress in chronic hemodialysis patients. Int Urol Nephrol, 2016, 48(11): 1887-1895.
41. 张兰, 程艳娇, 赵新菊, 等. 卧位体操对维持性血液透析患者毒素清除和炎症状态影响的研究. 中国血液净化, 2017, 16(4): 247-250.
42. 易建伟, 何志红, 袁峰. 阿司匹林肠溶片对维持性血液透析患者炎症因子的影响. 江西医药, 2018, 53(7): 722-724.
43. 易晔, 卢远航, 冀倩倩. 高通量血液透析对糖尿病肾病透析患者氧化应激及微炎症状态的影响. 重庆医学, 2015, 44(19): 2667-2669.
44. 曹宁. 肾功能衰竭患者采用不同血液透析膜材料的生物相容性对比分析. 中国组织工程研究, 2012, 16(25): 4727-4734.

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