Сorrection of nutritional status violations by a diet in patiets on maintenance hemodialysis with and without diabetes type 2
Tishkina S.V., Mikhailova N.A., Kartsev A.M., Tishkina A.V., Pushkina A.V., Derinova E.A.
1) State Budget Healthcare Institution of Moscow Healthcare Department City Hospital n.a. N.I. Pirogov, Moscow, Russia;
2) Federal State Budgetary Educational Institution of Further Professional Education Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare, Moscow, Russia;
3) Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia;
4) «Fespharm» LLC, Moscow, Russia;
5) Federal State Institution National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation (NMRС TPM), Moscow, Russia
Background. Protein-energy wasting (PEW) is widespread condition among patients receiving maintenance hemodialysis (MH). A serious destabilizing factor in nutritional status is insulin resistance and chronic inflammation, which are especially pronounced in the presence of diabetes mellitus in addition to chronic kidney disease. Given that type 2 diabetes mellitus (T2DM) has become one of the leading causes of end-stage chronic kidney disease (ESRD), it is especially important to develop an effective strategy to resist the progression of protein depletion and ensure better survival and quality of life in such patients. We believe that identifying inadequate intake of essential nutrients and calories, dietary counseling and diet correction can make a noticeable beneficial effect on nutritional status and the degree of chronic inflammation in patients with PEW, including those with T2DM.
The aim of the study. To assess the efficacy of diet therapy in the correction of metabolic disorders based on a comprehensive assessment of the nutritional status and dynamics of chronic inflammation biomarkers in patients with CKD and T2DM on MH.
Material and methods. The study involved 79 patients (mean age 62.0±11 years), with an average duration of MH 10.0±5.4 years. Patients were divided into 2 groups: with T2DM (T2DM+, n=40) and without T2DM (T2DM-, n=39). In both groups, an analysis of the nutritional status of patients was carried out (using physical, laboratory and instrumental parameters), the data of protein, fat and carbohydrates dietary intake were collected and analyzed on the basis of food diaries. All patients were prescribed an individual corrective diet in order to bring the parameters of the diet to those recommended for patients on MH, in the T2DM group – taking into account the compensation of hyperglycemia. Soy isolate was used as an additional source of complete protein. The dynamics of changes in indicators of nutritional status and chronic inflammation from baseline in both groups was monitored after 6 and 12 weeks of diet therapy. A comparative analysis of the dynamics of indicators between the groups was carried out.
Results. PEW was 2 times more frequent in the group with T2DM – 26 (65%) patients; in the group without T2DM, PEW was diagnosed only in 11 (28%) patients. The initial bioimpedance data obtained indicated a more frequent presence in patients with T2DM of "sarcopenic obesity": reduced lean mass in the presence of increased body fat and increased waist circumference. The severity of chronic inflammation, according to the corresponding biomarkers (interleukines 1 and 6, advanced glycation endproducts, C-reactive protein) was also higher in the T2DM+ group. The diet of diabetic patients was poorer in all macronutrients and significantly lower in energy supply. After correcting the composition of the diet for macronutrients and calories, positive changes in some of the objective indicators of nutritional status and biomarkers of chronic inflammation were noted in both groups by the end of the study (12 weeks). These changes were more evident in the T2DM+ group.
Conclusion. The presence of T2DM in patients with CKD on MH significantly aggravates the disturbances in nutritional status and increases the degree of chronic inflammation in comparison with patients without T2DM. Conducted adequate dietary therapy based on the obtained indicators of nutritional status and food diaries can reduce the degree of chronic inflammation and PEW in this category of patients.
About the Autors
Tishkina Svetlana Vladimirovna, nephrologist of 1-st City Hospital n.a. N. I. Pirogov, Moscow. 119049 Moscow, Leninsky av.,8. e-mail: firstname.lastname@example.org
Mikhailova Nataliia Alexeevna, PhD, associate professor of Nephrology Department of Russian medical academy of continuous professional education. Moscow.
125284 Moscow, 2-nd Botkinsky proezd, 5; e-mail: email@example.com. ORCID: https://orcid.org/0000-0001-5819-4360
Kertsev Andrey Mikhailovich, PhD, nephrologist of 1-st City Hospital n.a. N. I. Pirogov, Moscow. 119049 Moscow, Leninsky av.,8. e-mail: firstname.lastname@example.org
Tishkina Anna Victorovna resident physician of Pirogov Russian National Research Medical University (RNRMU), Moscow. 117997 Moscow, Ostrovitianinov st. 1.
Pushkina Anna Vyatcheslavovna, PhD, Head physician of Fespharm LLC Clinic, Moscow. 121170 Moscow, Neverovsky st., 10, bld 3A. e-mail: email@example.com
Derinova Elena Alexandrovna, PhD, senior teacher of Federal State Institution National Medical Research Center for therapy and Preventive Medicine of the Ministry
of Healthcare of the Russian Federation (NMRС TPM). e-mail: firstname.lastname@example.org ORCID: https://orcid.com/0000-0001-9146-4625