Effect of Different Nutritional Education Based on Healthy Eating Index for HemoDialysis Patients on Dietary Quality and Muscle Mass.

BACKGROUND: Hemodialysis patients are at high risk of muscle loss as a result of aging and disease, and combined with inadequate dietary intake. The Healthy Eating Index for HemoDialysis patients (HEI-HD) was developed to assess the dietary quality of hemodialysis patients. The purposes of this study were to examine the effects of different nutritional education models using HEI-HD-based education on dietary quality and muscle mass in hemodialysis patients. METHODS: A quasi-experimental study was conducted from May 2019 to April 2021, with four groups, including no course for patients and nurses (Non-C), course for nurses (CN), course for patients (CP), and course for patients and nurses (CPN). The courses were delivered by registered dietitians. The data of 94 patients were collected and analyzed at baseline, after 2 months of intervention, and 2 months follow-up, including demographics, body composition, 3-day dietary records, and hemodialysis dietary knowledge. The HEI-HD index score was calculated. RESULTS: Patients aged 58.3 ± 10.1 years. The dietary quality change in the CPN group was improved as compared with the Non-C group (-3.4 ± 9.5 vs. 3.0 ± 5.5, 0.04). The skeletal muscle mass of the Non-C group at intervention was also significantly lower than baseline, but the CPN group was not. CONCLUSIONS: The HEI-HD-based nutritional education for both patients and nurses showed a positive effect on improving the dietary quality and maintaining muscle mass in hemodialysis patients.

The Effect of Different Nutritional Education Models on Reducing Cardiovascular Disease Risk Factors by Improving Dietary Fat Quality in Hemodialysis Patients.

Cardiovascular disease (CVD) is the most common complication in hemodialysis patients. Nutritional education provided by dietitians could improve overall dietary quality and dietary fat quality to reduce the risk of CVD. However, no studies have investigated the relationship between dietary fat quality (using the hypocholesterolemic/hypercholesterolemic ratio, or the h/H) and CVD risk factors in hemodialysis patients. The aim of this study was to examine the association between the h/H and CVD risk factors, and further explore how nutritional education intervention models could improve dietary fat quality and CVD risk factors in hemodialysis patients. A quasi-experimental design was conducted from May 2019 to April 2021 on four groups, including 'no course for patients and nurses' as the non-C group, a "course for nurses" as the CN group, a "course for patients" as the CP group, and a "course for patients and nurses" as the CPN group. Nutritional education booklets based on a healthy eating index for hemodialysis patients were developed and provided to patients and nurses. Data of 119 patients were collected at baseline, intervention, and follow-up periods, including patients' basic information, blood biochemical data, dietary content, and calculated h/H. The results showed that the h/H was negatively correlated with body mass index (BMI) and positively correlated with high-density lipoprotein cholesterol (HDL-C). Compared with the non-C group, the CPN group was significantly higher in the h/H as well as HDL-C, and significantly lower in serum total cholesterol. In conclusion, the h/H was found to predict CVD risk factors, which helps in improving dyslipidemia. Nutritional education for both patients and nurses showed a beneficial impact on reducing CVD risks in hemodialysis patients.

Energy Requirement of Patients Undergoing Hemodialysis: A Cross-Sectional Study in Multiple Centers.

BACKGROUND: Energy requirements must be estimated before nutritional care can be provided for patients undergoing hemodialysis (HD). However, the recommended caloric intake for patients has not been conclusively determined because of insufficiently large sample sizes. METHOD: This cross-sectional observational study recruited patients undergoing long-term HD from multiple centers as well as people in the general population without chronic kidney disease. People from both groups were matched by sex and age. Resting energy expenditure (REE) was estimated using an indirect calorimeter. Two commonly used equations for estimating REE and daily energy requirement recommended by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (K/DOQI) were chosen. RESULTS: This study had 154 HD patients and 33 matched HD-control group pairs. Age (r = -0.36, p < 0.01) and dry body weight after dialysis (r = -0.36, p < 0.01) and dry body weight after dialysis (. CONCLUSIONS: Age and dry body weight are the main factors affecting the energy expenditure of HD patients. Furthermore, predicting the energy expenditure of HD patients by measuring the energy expenditure of their sedentary counterparts in the general population with the same sex, age range, and weight may yield better results than using traditional equations for predicting TEE. In East Asian populations, the TEE values were 32 and 30 kcal/kg dry weight for those aged <65 and ≥65 years, respectively. Future prospective cohort studies with larger sample sizes are needed.

Insulin Resistance and Cardiovascular Risks in Different Groups of Hemodialysis Patients: A Multicenter Study.

BACKGROUND: To investigate the association between insulin resistance (IR) and cardiovascular disease (CVD) risks among hemodialysis patients. METHODS: We conducted a cross-sectional study between 2013 and 2017, on 384 hemodialysis patients from seven hospital-based-dialysis centers. HOMA-IR is classified according to median value. The CVD risks were defined by the K/DOQI Guidelines. Logistic regression analysis was used. RESULTS: Patients' age was 60.9 ± 11.8, 58.1% men, and 40.3% overweight/obese. The median of HOMA-IR was 5.4, 82.8% high systolic blood pressure, and 85.7% hyperhomocysteinemia. In multivariate analysis, IR was significantly associated with higher odds of low high-density lipoprotein cholesterol, high triglyceride, and impaired fasting glucose in groups of normal weight, overweight/obese, nondiabetes, diabetes, and overall sample. IR linked with elevated high-sensitive C-reactive protein in normal weight patients (odd ratio, OR=2.21, 95% confidence interval, 1.16-4.22, p < .05), with hypoalbuminemia in normal weight patients (OR=8.31, 95% CI, 2.35-29.37, p < .01), in nondiabetes patients (OR=6.59, 95% CI, 1.81-23.95, p < .01), and overall sample (OR=3.07, 1.51-6.23, p < .01). CONCLUSIONS: The level of IR and prevalence of CVD risks were high in hemodialysis patients. IR was independently associated with CVD risks.

Hyperhomocysteinemia Associated with Low Muscle Mass, Muscle Function in Elderly Hemodialysis Patients: An Analysis of Multiple Dialysis Centers.

BACKGROUND: The hyperhomocysteinemia was with high prevalence and has been considered as a risk factor for cardiovascular disease in hemodialysis patients. These patients also experienced a high risk of muscle wasting caused by the comorbidity, malnutrition, and low physical activity. We investigated the associations of homocysteinemia with muscle mass, muscle function in elderly hemodialysis patients. METHODS: A clinical cross-sectional study was conducted on 138 hemodialysis patients aged 65 years and above in seven hospital-based hemodialysis centers in Taiwan. The data on anthropometry, laboratory, and 3-day dietary intake was examined. The skeletal muscle mass (SMM) was measured by the bioelectrical impedance analysis; the SMM was adjusted by height or weight as SMMHt2 (kg/m2) and SMMWt (%). Muscle function was defined as handgrip strength (HGS) (kg) measured by handgrip dynamometer. Statistical analyses were conducted using simple regression and multivariable stepwise regression analysis. RESULTS: In the total sample, 74.6 % of hemodialysis patients were hyperhomocysteinemia (≥ 15 µmol/L). The means of SMMHt2, SMMWt, arm lean mass, hand grip strength, and muscle quality were 8.7 ± 1.2, 37.7 ± 5.6, 1.7 ± 0.5, 21.1 ± 7.4, and 10.0 ± 3.0, respectively. The multivariable stepwise regression analysis showed that homocysteinemia level was significantly inversely associated with SMMWt (B-coeff. = -0.03, p = 0.02) in hemodialysis patients above 65 years old, but not with muscle function. CONCLUSIONS: Hyperhomocysteinemia is common and associated with decreased muscle mass in the elderly hemodialysis patients. Future studies are suggested to explore the impact of the homocysteine-lowering therapy on muscle decline.

Adaptation and Validation of Alternative Healthy Eating Index in Hemodialysis Patients (AHEI-HD) and Its Association with all-Cause Mortality: A Multi-Center Follow-Up Study.

A valid diet quality assessment scale has not been investigated in hemodialysis patients. We aimed to adapt and validate the alternative healthy eating index in hemodialysis patients (AHEI-HD), and investigate its associations with all-cause mortality. A prospective study was conducted on 370 hemodialysis patients from seven hospital-based dialysis centers. Dietary data (using three independent 24-hour dietary records), clinical and laboratory parameters were collected. The construct and criterion validity of original AHEI-2010 with 11 items and the AHEI-HD with 16 items were examined. Both scales showed reasonable item-scale correlations and satisfactory discriminant validity. The AHEI-HD demonstrated a weaker correlation with energy intake compared with AHEI-2010. Principle component analysis yielded the plateau scree plot line in AHEI-HD but not in AHEI-2010. In comparison with patients in lowest diet quality (tertile 1), those in highest diet quality (tertile 3) had significantly lower risk for death, with a hazard ratio (HR) and 95% confidence intervals (95%CI) of HR: 0.40; 95%CI: 0.18 - 0.90; p = 0.028, as measured by AHEI-2010, and HR: 0.37; 95%CI: 0.17-0.82; p = 0.014 as measured by AHEI-HD, respectively. In conclusion, AHEI-HD was shown to have greater advantages than AHEI-2010. AHEI-HD was suggested for assessments of diet quality in hemodialysis patients.

Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study.

The association between body fat and mortality in hemodialysis patients remains controversial. We examined the effect of percent body fat (PBF) on all-cause mortality among adequate hemodialysis patients with and without insulin resistance (IR). A prospective cohort study was conducted on 365 adequate hemodialysis patients (equilibrated Kt/V ≥ 1.2) from seven hospitals. Patients' characteristics and clinical and biochemical parameters were assessed at baseline between September 2013 and April 2017. Patients were followed up for all-cause mortality until April 2018. The median value of homeostatic model assessment (HOMA-IR) was used to classify IR. Cox proportional hazard models were utilized to examine predictors of all-cause mortality. During 1.4 (1.0-3.2) years of follow-up, 46 patients died. In patients with IR (HOMA-IR ≥ 5.18), PBF was significantly higher in the survival group than in the death group (31.3 ± 9.0 vs. 25.4 ± 8.2, p = 0.005). After controlling for confounding factors, PBF was significantly associated with lower risk for all-cause mortality in patients with IR (hazard ratio, 0.94; 95% confidence interval, 0.89-1.00; p = 0.033). The association was not observed in patients without IR. In conclusion, percent body fat shows a protective effect on survival in hemodialysis patients with IR.

Mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, dialysis adequacy influence all-cause mortality in hemodialysis patients: A prospective cohort study.

Hemodialysis patients are at the high risk for morbidity and mortality. Evaluation and management of body composition and biochemical values are important to improve dialysis outcomes. We aimed to examine the effects of the mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, and dialysis adequacy on the mortality.A prospective cohort study was conducted on 375 patients from 7 hospital-based dialysis centers. At baseline between September 2013 and April 2017, we assessed patients' characteristics using chart review, body composition using the bioelectrical impedance analysis, and biochemical parameters using available laboratory tests. Patients were followed-up for all-cause mortality until April 2018. Kaplan-Meier Curves with Log-rank test, and Cox proportional hazards models were used to analyze the effects of assessed factors on the mortality.During the median of follow-up time of 1.4 (1.0-3.2) years, 47 (12.5%) patients died. In the multivariate analysis, mid-arm circumference (hazard ratio, HR, 0.90; 95% confidence interval, 95%CI, 0.82-0.99; P = .036), body fat mass (HR, 0.95; 95%CI, 0.91-1.00; P = .031), percent body fat (HR, 0.96; 95%CI, 0.92-0.99; P = .024), serum creatinine (HR, 0.81; 95%CI, 0.68-0.96; P = .015), and eKt/V (HR, 0.07; 95%CI, 0.01-0.33; P = .001) reduced the mortality risk. Inflammation (HR, 2.90; 95%CI, 1.59-5.27; P < .001), hyperglycemia (HR, 2.16; 95%CI, 1.06-4.40; P = .033), and low serum uric acid (HR, 2.22; 95%CI, 1.15-4.31; P = .018) increased the death risk.In hemodialysis patients, the higher values of the mid-arm circumference, body fat, serum creatinine, uric acid, and dialysis adequacy were associated with lower mortality, whereas, inflammation and hyperglycemia associated with higher mortality.

Inadequate dietary energy intake associates with higher prevalence of metabolic syndrome in different groups of hemodialysis patients: a clinical observational study in multiple dialysis centers.

BACKGROUND: Metabolic syndrome (MetS) has been established as a risk for cardiovascular diseases and mortality in hemodialysis patients. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients. METHODS: A cross-sectional study design was carried out from September 2013 to April 2017 in seven hemodialysis centers. Data were collected from 228 hemodialysis patients with acceptable EI report, 20 years old and above, underwent three hemodialysis sessions a week for at least past 3 months. Dietary EI was evaluated by a three-day dietary record, and confirmed by 24-h dietary recall. Body compositions were measured by bioelectrical impedance analysis. Biochemical data were analyzed using standard laboratory tests. The cut-off values of daily EI were 30 kcal/kg, and 35 kcal/kg for age ≥ 60 years and < 60 years, respectively. MetS was defined by the American Association of Clinical Endocrinologists (AACE-MetS), and Harmonizing Metabolic Syndrome (HMetS). Logistic regression models were utilized for examining the association between EI and MetS. Age, gender, physical activity, hemodialysis vintage, Charlson comorbidity index, high sensitive C-reactive protein, and interdialytic weight gains were adjusted in the multivariate analysis. RESULTS: The prevalence of inadequate EI, AACE-MetS, and HMetS were 60.5%, 63.2%, and 53.9%, respectively. Inadequate EI was related to higher proportion of metabolic abnormalities and MetS (p <  0.05). Results of the multivariate analysis shows that inadequate EI was significantly linked with higher prevalence of impaired fasting glucose (OR = 2.42, p <  0.01), overweight/obese (OR = 6.70, p <  0.001), elevated waist circumference (OR = 8.17, p <  0.001), AACE-MetS (OR = 2.26, p <  0.01), and HMetS (OR = 3.52, p <  0.01). In subgroup anslysis, inadequate EI strongly associated with AACE-MetS in groups of non-hypertension (OR = 4.09, p = 0.004), and non-cardiovascular diseases (OR = 2.59, p = 0.012), and with HMetS in all sub-groups of hypertension (OR = 2.59~ 5.33, p <  0.05), diabetic group (OR = 8.33, p = 0.003), and non-cardiovascular diseases (OR = 3.79, p <  0.001). CONCLUSIONS: Inadequate EI and MetS prevalence was high. Energy intake strongly determined MetS in different groups of hemodialysis patients.

Associations of dietary macronutrients and micronutrients with the traditional and nontraditional risk factors for cardiovascular disease among hemodialysis patients: A clinical cross-sectional study.

The current study was to examine the association of adequate intake of macronutrients and micronutrients with traditional and nontraditional cardiovascular risk factors in hemodialysis patients.A clinical cross-sectional study was conducted between September 2013 and April 2017 on 492 hemodialysis patients aged 20 years and above, received thrice-weekly hemodialysis treatment for at least 3 months, adequate dialysis quality (equilibrated Kt/V ≥ 1.2 g/kg/d) from 7 hospital-based hemodialysis centers in Taiwan. The dietary intake was evaluated by the 3-day dietary record, and a 24-hour dietary recall. Biochemical parameters were archived from laboratory tests. The cardiovascular disease (CVD) risk factors were defined by the Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines. The adequate dietary intake of macronutrients and micronutrients was recommended by the European Best Practice Guidelines, K/DOQI, and Institute of Medicine guidelines. Logistic regression analysis was used.All hemodialysis patients had CVD risks, the lowest proportion of patients with adequate intake of macronutrients and micronutrients were 8.7% and 1.8%, respectively. The adequate dietary intake associated with lower likelihood of having CVD risks in hemodialysis patient by 47% to 84%, including 39% to 58% lower hypertension, 37% to 50% lower dyslipidemia, 42% to 63% diabetes mellitus, 44% to 84% lower obesity, 58% lower low calcium, 38% lower hyperparathyroidism, 47% to 64% lower hyperhomocysteinemia, and 41% to 67% lower inflammation, 63% to 74% lower hypoalbumin, 73% lower inadequate normalized protein nitrogen appearance.Adequate dietary nutrients intake may reduce the cardiovascular risks factors, in turn, to prevent the cardiovascular morbidity and mortality.

The cut-off values of dietary energy intake for determining metabolic syndrome in hemodialysis patients: A clinical cross-sectional study.

Dietary energy intake strongly linked to dialysis outcomes. We aimed to explore the optimal cut-off point of energy intake (EI) for identification of metabolic syndrome (MetS) in hemodialysis patients. The cross-sectional data of 243 hemodialysis patients from multi-dialysis centers in Taiwan was used. The dietary intake was assessed by using the three-day dietary questionnaire, and a 24-hour dietary recall, clinical and biochemical data were also evaluated. The MetS was diagnosed by the Harmonized Metabolic Syndrome criteria. The receiver operating characteristic (ROC) curve was to depict the optimal cut-off value of EI for the diagnosis of MetS. The logistic regression was also used to explore the association between inadequate EI and MetS. The optimal cut-off points of EI for identifying the MetS were 26.7 kcal/kg/day for patients aged less than 60 years, or with non-diabetes, and 26.2 kcal/kg/day for patients aged 60 years and above, or with diabetes, respectively. The likelihood of the MetS increased with lower percentiles of energy intake in hemodialysis patients. In the multivariate analysis, the inadequate dietary energy intake strongly determined 3.24 folds of the MetS. The assessment of dietary EI can help healthcare providers detecting patients who are at risk of metabolic syndrome.

Evaluating Hyponatremia in Non-Diabetic Uremic Patients on Peritoneal Dialysis.

UNLABELLED: ♦ BACKGROUND: An approach to hyponatremia in uremic patients on peritoneal dialysis (PD) necessitates the assessment of intracellular fluid volume (ICV) and extracellular volume (ECV). The aim of the study was to evaluate the association of plasma sodium (Na(+)) concentration and body fluid composition and identify the causes of hyponatremia in non-diabetic PD patients. ♦ METHODS: Sixty non-diabetic uremic patients on PD were enrolled. Baseline body fluid composition, biochemistry, hand-grip test, peritoneal membrane characteristics, dialysis adequacy, Na(+) and water balance, and residual renal function (RRF) were measured. These parameters were reevaluated for those who developed hyponatremia, defined as serum Na(+) concentration < 132 mmol/L and a decline in serum Na(+) > 7 mmol/L, during monthly visits for 1 year. Body fluid composition was determined by multi-frequency bioelectrical impedance (BIA). ♦ RESULTS: There was no significant correlation between serum Na(+) concentrations and any other parameters except a negative correction with overnight ultrafiltration (UF) amount (p = 0.02). The ICV/ECV ratio was positively correlated with serum albumin (p < 0.005) and hand grip strength (p < 0.05). Over 1 year, 9 patients (M:F = 3:6, aged 35 - 77) with 4 different etiologies of hyponatremia were identified. Hyponatremic patients with a body weight (BW) loss had either an increased ICV/ECV ratio associated with primarily a negative Na(+) balance (n = 2) or a reduced ratio of ICV/ECV associated with malnutrition (n = 2). In contrast, hyponatremic patients with a BW gain had either a reduced ICV/ECV ratio associated with a rapid loss of RRF and a higher peritoneal permeability (n = 2) or a normal to increased ICV/ECV ratio associated with high water intake (n = 3). ♦ CONCLUSION: Besides BW change and ultrafiltration rate, the assessment of ICV/ECV ratio is valuable in identifying the etiologies of hyponatremia in PD and provides a guide for optimal therapy.

Yellowish discoloration of dialyzer.

A 43-year-old Chinese man with chronic viral hepatitis and end-stage renal disease, receiving conventional hemodialysis for 6 years, presented with general malaise and abdominal fullness. After 4.5 hours of hemodialysis, the hollow fibers of the dialyzer turned yellow. Biochemistry studies showed hyperbilirubinemia. The actual serum bilirubin (7.4 mg/dL) could be proved. Abdominal echography survey was negative. Hyperbilirubinemia was secondary to acute exacerbation of chronic viral hepatitis. Anuria and skin hyperpigmentation in uremia lack the tea-color urine and mask clinical jaundice in the presence of hyperbilirubinemia. Careful observation of dialyzer yellowish discoloration gave us timely discovery of patient's hyperbilirubinemia.

Association of leptin with hemodialysis-related muscle cramps: a cross-sectional study.

BACKGROUND/AIMS: The mechanism of muscle cramp in hemodialysis patients is not well understood. Leptin, a middle molecule uremic toxin, is able to affect neuronal activity. This study aimed to determine the association between leptin and hemodialysis-related muscle cramps. METHODS: A total of 79 hemodialysis patients were enrolled. The episodes of hemodialysis-related muscle cramps were recorded over a 28-day period. Serum levels of leptin were measured on the 15th day, a mid-week dialysis session. RESULTS: Frequent hemodialysis-related cramps were associated with old age and elevated serum leptin levels. The risk of frequent hemodialysis-related cramps increased with increasing tertiles of leptin concentration. This relationship remained significant after adjustment for age, mean ultrafiltration ratio, gender, body mass index, insulin, resistin, c-reactive protein, albumin, peripheral arterial disease, electrolytes, and beta(2)-microglobulin. CONCLUSION: Leptin levels are associated with frequent hemodialysis-related cramps. Further studies are necessary to elucidate the underlying mechanisms.

Effects of various soya protein hydrolysates on lipid profile, blood pressure and renal function in five-sixths nephrectomized rats.

Studies have demonstrated that isolated soya protein (ISP) can slow the progression of renal injury, reduce blood pressure and improve the serum lipid profile in experimental animals and human subjects. The mechanisms and components of soya responsible have not been fully established. The present study was designed to evaluate the effects of the hydrophilic supernatant fraction (SF) and the hydrophobic precipitate fraction (PF) isolated from soya protein hydrolysate on renal function, lipid metabolism and blood pressure in five-sixths nephrectomized rats. Experimental animals were subjected to a nephrectomy and allocated to four groups (180 g casein/kg, 180 g ISP/kg, 100 g casein/kg with 80 g SF/kg, and 100 g casein/kg with 80 g PF/kg). The SF group had the most significant decreases in blood pressure and total cholesterol, as well as a significantly retarded progression of the experimentally induced renal disease, compared with the other groups. The PF group exhibited a significantly increased faecal excretion of total steroids. The serum creatinine, level of proteinuria, total cholesterol and LDL-cholesterol concentrations, and blood pressure were significantly reduced, and HDL-cholesterol was significantly increased, in the ISP and PF groups compared with the casein group, but no significant differences were observed between the ISP and PF groups. These results suggest that both soya protein hydrolysate fractions favourably affected chronic renal failure induced by a five-sixths nephrectomy, and the hydrophilic fraction of soya protein hydrolysate had the most pronounced effect on attenuating hypertension and slowing the progression of renal disease.

Effect of soya protein on serum lipid profile and lipoprotein concentrations in patients undergoing hypercholesterolaemic haemodialysis.

Clinical trials have shown that soya protein reduces the concentrations of some atherogenic lipids in subjects with normal renal function. The present study examined the effects of soya protein on serum lipid concentrations and lipoprotein metabolism in patients on hypercholesterolaemic haemodialysis. Twenty-six hypercholesterolaemic (total cholesterol > or =6.21 mmol/l) patients on haemodialysis were studied in a randomized, double-blind, placebo-controlled clinical trial. After a 4-week run-in phase, the subjects were randomly assigned to two groups. Isolated soya protein or milk protein 30 g was consumed daily as a beverage at breakfast or post-dialysis for 12 weeks. Soya protein substitution resulted in significant reductions in total cholesterol (17.2 (sd 8.9 )%), LDL-cholesterol (15.3 (sd 12.5 )%), apo B (14.6 (sd 12.1 )%) and insulin (23.8 (sd 18.7) %) concentrations. There were no significant changes in HDL-cholesterol or apo A-I. These results indicate that replacing part of the daily protein intake with soya protein has a beneficial effect on atherogenic lipids and favourably affects lipoprotein metabolism in hypercholesterolaemic patients undergoing haemodialysis.

Variable effects of soy protein on plasma lipids in hyperlipidemic and normolipidemic hemodialysis patients.

BACKGROUND: Hyperlipidemic factors contribute to the high cardiovascular risk in hemodialysis patients. Soy protein has decreased some atherogenic lipid concentrations in subjects with normal renal function. This study evaluates the effect of soy protein on serum lipid profiles in hyperlipidemic and normolipidemic hemodialysis patients. METHODS: Nineteen hyperlipidemic and 18 normolipidemic hemodialysis patients were enrolled in a randomized, double-blind, placebo-controlled, clinical trial. After a 4-week run-in phase, subjects in each category were randomly assigned to 2 groups. Thirty grams of isolated soy protein or milk protein was consumed daily as a beverage at breakfast or postdialysis for 12 weeks. RESULTS: In hyperlipidemic subjects, soy protein intake significantly decreased total cholesterol levels by 18.6% (95% confidence interval [CI], -11.4 to -25.8; P = 0.04), triglyceride levels by 43.1% (95% CI, -34.0 to -52.2; P = 0.02), non-high-density lipoprotein cholesterol levels by 23.6% (95% CI, -14.7 to -32.5; P < 0.01), apolipoprotein B levels by 15.4% (95% CI, -5.4 to -25.4; P = 0.01), and insulin levels by 49.8% (95% CI, -23.3 to -66.1; P < 0.01). Low-density lipoprotein cholesterol concentration was decreased significantly (-25.8%; 95% CI, -8.3 to -42.7; P = 0.01), and high-density lipoprotein cholesterol level was increased significantly (17%; 95% CI, 2 to 32.0; P = 0.03), but there was no significant difference compared with the milk protein group (-5.5% +/- 16.9% and 7.0% +/- 11.8%, respectively). There were no significant changes in serum lipid and lipoprotein concentrations in normolipidemic subjects. CONCLUSION: These results indicate soy protein substitution has lipid-lowering effects in hyperlipidemic hemodialysis patients. However, soy protein intake had little effect on plasma lipid levels in normolipidemic hemodialysis patients.

Isolation effectively prevents the transmission of hepatitis C virus in the hemodialysis unit.

BACKGROUND AND PURPOSE: Many preventative strategies have been proposed to control hepatitis C virus (HCV) infection in the hemodialysis unit. The effectiveness of isolation as a preventive policy remains unclear. The aim of this study was to evaluate the effect of an isolation policy on the incidence of hepatitis C in our hemodialysis unit. METHODS: A total of 325 hemodialysis patients with a mean age of 62 +/- 14 years and a mean duration of dialysis of 4.8 +/- 4.4 years, who were treated from January 1993 to December 2000 were included in this retrospective study. Data were collected from medical records. HCV antibody was monitored at 6-month intervals. During the period before September 1997 all patients were dialyzed in a single room. Isolation started after September 1997, when an additional room became available. Patients positive for either hepatitis B or C were clustered in 1 area (Area 1). Anti-HCV-negative and hepatitis B surface antigen (HBsAg)-negative patients were assigned either to a segregated zone (Area 2) adjacent to Area 1 in the same room or to a separate independent room (Area 3). Dialyzers were not reused and hygienic precautions remained the same throughout the study period. RESULTS: Forty months after the implementation of the isolation policy, there was significant reduction in the total prevalence (49.7 vs 31.7%, p < 0.01) and incidence (9.1 vs 2.9 % patient-years, p < 0.01) of HCV infection. Seroconversion of anti-HCV was detected in 9 patients, 7 in Area 1, 2 in Area 2, with no new cases in Area 3. The incidence of seroconversion of anti-HCV was significantly different in the 3 areas. Regression analysis indicated that isolation was the most prominent independent factor in reducing seroconversion of anti-HCV. CONCLUSIONS: These results support the use of an isolation policy to combat HCV infection among hemodialysis patients, particularly in high prevalence units.

Effects of dietary protein on renal function and lipid metabolism in five-sixths nephrectomized rats.

The objective of the present experiment was to examine the effect of substituting different quantities of soyabean protein for casein on renal function and lipid metabolism in rats with chronic renal failure induced by a five-sixths nephrectomy. Experimental animals were subjected to a nephrectomy and fed either casein or soyabean protein (200 or 100 g/kg diet). The diets were isoenergetic with identical fat, Na, K and P contents. Rats ingesting 200 g casein/kg diet showed a significantly (P<0.05) accelerated course of chronic renal failure, while the soyabean-protein groups showed retarded progression of the experimentally induced renal disease and hypercholesterolaemic effects. Rats in the low-soyabean-protein diet (100 g/kg) also demonstrated increased serum albumin and decreased serum triacylglycerol, total cholesterol concentrations and blood urea-N; however, the low-casein diet significantly (P<0.05) increased serum triacylglycerol. Results of the present study show that the replacement of casein by soyabean protein was related to the rate of progression of renal failure and improvement in lipid profiles in serum of five-sixths nephrectomized rats.