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   Table of Contents - Current issue
January-March 2019
Volume 5 | Issue 1
Page Nos. 1-33

Online since Friday, November 15, 2019

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Striking balance between protein requirement and dietary phosphorus restrictions p. 1
Anita Saxena
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Slipping into darkness: How starvation eats away vital organs p. 2
Anita Saxena
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Probiotic supplementation and reducing infiammation in hemodialysis patients: A systematic review p. 3
Kirsten N Abney, Susan J Hewlings
Background: Chronic kidney disease (CKD) is a growing health problem worldwide. Uremic toxin buildup caused by protein bacterial metabolites such as indoleamines, urea, and indoxyl sulfate contribute to dysbiosis in the gut microbiome in hemodialysis patients, which contributes to a pro-infiammatory environment. Aims: This systematic review of the literature considers the confiicting evidence on probiotic supplementation and infiammatory status in CKD patients receiving hemodialysis. Methods: PubMed, EBSCO, and Google Scholar were all used to search for control/clinical trials demonstrating the effects of probiotic supplementation on these protein bacterial metabolites and C-reactive protein (CRP) levels. Results: Four of the five studies observed no significant findings in the reduction of infiammatory status in this population. One study demonstrated a significant reduction in CRP levels after 3 months of probiotic supplementation. Many articles varied between using single and multiple strains of bacteria which contributed to limitations to the studies. There was limited supporting evidence to suggest that probiotic supplementation could reduce infiammatory status in hemodialysis patients. Conclusions: Based on the findings, more research is needed before any conclusive recommendations can be made on whether probiotic supplementation would be beneficial for patients receiving hemodialysis treatments.
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Translating growth and nutrition guidelines for children with chronic renal failure and chronic kidney disease Stages 2–5 and 5D into practice p. 7
Dharshan Rangaswamy
There is a remarkable lack of published data available for the topic of nutrition in children in all stages of CKD. Kidney Disease Outcomes Quality Initiative (KDOQI) published their guidelines for children on maintenance dialysis in the year 2000 to address the concerns of malnutrition and growth failure in them. In the 2008 update, they included infants, children, and adolescents with chronic kidney disease (CKD) stage 2 to 5 and also children on long term dialysis or renal transplant. The quality of evidence in the guidelines involving pediatric nephrology studies are frequently low due to small sample size, the lack of randomized control trials and the lack of information for long and short term clinical outcomes. With the current available data the article address the practical key components for nutritional management of children with CKD and thus reduce the risk of chronic morbidities in adulthood.
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Refeeding syndrome – Intensive care p. 10
Afzal Azim
Refeeding syndrome is a life-threatening condition resulting from over-rapid or unbalanced nutrition support given to malnourished patients. It usually occurs within 4 days of starting to feed. With starvation, levels of glucose begin to fall within 24–72 h. There is a resultant loss of body fat and protein and an accompanying depletion of potassium, phosphate, and magnesium.The reintroduction of nutrition to a starved or fasted individual results in a rapid decline in both gluconeogenesis and anaerobic metabolisms. The principle is to gradually step up the calories intake over a period of 3–5 days and at the same time keep a watch on electrolytes and continue with thiamine supplementation.
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Protein delivery in critical care p. 12
Rimita Dey
Evidence suggests that improving the nutritional status has potential to improve the recovery of critically ill patients. Critically ill patients are at high risk of developing malnutrition due to various factors. Patients who develop sepsis, require prolonged ventilation and therefore are also at risk of developing neuromuscular paresis and have a high risk of mortality. Evidence suggests that improving the nutritional status has potential to improve the recovery of critically ill patients. This article deals with the importance of protein delivery in critically ill patients and how to monitor the adequacy of protein delivery.
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Prevention of acute kidney injury in the clinical practice: The whole at a glance p. 17
Dimitrios C Karathanasis, Androula C Karaolia, Georgios I Tagarakis, Nikolaos B Tsilimingas, Ioannis Stefanidis
The gradual formation and the final acceptance of a definition of acute kidney injury highlighted the importance of prevention as it contributed to the recording of its impact on the parameters of mortality, the economic burden on health systems, and the progression to chronic kidney disease. Prevention could be separated into general principles and specific clinical cases. The general principles include early diagnosis with the identification of predisposing factors and use of electronic warning and biomarker systems, adequate renal perfusion by administering fiuid and vasomotor drugs, and finally avoidance of nephrotoxicity and administration of nephroprotective drugs. More frequent clinical cases are the postoperative, and also contrast-induced acute kidney injury, which implies both assessments of contrast need and hydration depending on the level of renal function. Despite the ongoing acute kidney injury research, prevention remains the main parameter to address it and needs the utmost attention and application in clinical practice.
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Evaluation of nutritional status among patients undergoing hemodialysis: A single-center study p. 23
Gurvinder Randhawa, Manish Kumar Singla
Background: Protein–energy malnutrition (PEM) is a highly prevalent problem affecting the survival of hemodialysis (HD) patients. This study evaluated the nutritional status of HD patients using various assessment methods. Methods: Nutritional status of HD patients was evaluated using assessment tools such as 3-day diet recall, subjective global assessment (SGA), and biochemical and anthropometric measurements. Further, correlation analysis was performed between nutritional marker (serum albumin) and other study variables such as hemoglobin (Hb), protein–calorie intake, and type of diet consumed by the patients. Results: Data from 40 adult patients (aged 22–74 years) on HD were analyzed. The results of our study showed the overall good nutritional status of HD patients. According to SGA ratings, majority of the patient population (82%) was in well-nourished state. Despite lower intake of proteins and calories, serum albumin levels were found to be within normal limits. No significant correlation was found between serum albumin levels and other study parameters, namely, protein intake/kg body weight (BW)/day (r = 0.056, P = 0.73), calorie intake/kg BW/day (r = −0.053, P = 0.74), and Hb levels (r = 0.27, P = 0.18). However, body mass index showed moderately positive correlation with triceps skinfold (r = 0.35, P = 0.03). Further, no significant relationship was observed between the type of diet consumed and serum albumin levels (P > 0.05). Conclusion: The results suggest overall good nutritional status and absence of relationship between nutritional marker, serum albumin, and PEM in HD patients.
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Why is acute kidney injury more demanding in terms of nutritional support? p. 28
Hemant Mehta
Treatment for acute kidney injury (AKI) primarily relies on treating the underlying cause and maintaining the patient until kidney function has recovered. Enteral and parenteral nutrition are commonly used to treat nutritional disorders in AKI patients; however, their efficacy in treating AKI are still debated. This article focuses on nutritional requirements of patients with AKI.
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Approach to nutrition in children with chronic kidney disease: What Do We Understand from the Kidney Disease Outcomes Quality Initiative on Nutrition and Chronic Renal Failure guidelines p. 32
Dharshan Rangaswamy
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Translating nutritional guidelines for post renal transplant children into practice p. 33
Dharshan Rangaswamy
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