Introduction: End-Stage Renal Disease is a common cause of undernutrition, with a high risk of morbidity and mortality in dialysis. To improve nutritional status before dialysis, we followed up 35 non-dialysed uremic diabetic patients in a prospective and cooperative study.
Methods: We analysed glomerular filtration rate (GFR, using 51Cr-EDTA), glycemic control (HbA1c), and nutritional status: body composition (lean body mass, LBM, by DEXA), serum albumin (SA) initially and after 2 yr. The results (means±sem) were compared by paired (initial time vs 2 yr) or unpaired Students t tests (groups with rapid or slow GFR evolution).
Results: The 35 patients (67% men, 67% type 2 diabetes) were followed up for 2 yr without dialysis. Initially their characteristics were: age 66±10 yr, BMI 26.5±4.2 kg/m2, HbA1C 8.0±1.2%, serum creatinine 162±64 μmol/l, GFR 42.5±20.5 ml/min/1.73 m2, SA 36.3±3.2 g/l.
After 2 yr, GFR decreased −6.5±16.7 ml/min/1.73 m2 (P=0.028). However, HbA1c −0.7±1.1 (P=0.001) and nutritional status were improved: weight +2.3±12.9 kg (P=0.026), BMI +0.7±4.4 kg/m2 (P=0.003), LBM +1.5±8.3 kg (P=0.003) and SA +3.1±3.4 g/l (P=0.048).
Initial BMI were higher in the 15 slowly progressing than in the 20 rapidly progressing patients (28.0±4.1 vs 24.9±3.7 kg, P=0.025). The former had stable GFR +4.7±10.6 ml/min/1.73 m2 (NS) the latter had decreasing GFR −21.5±10.4 ml/min/1.73 m2 (P=0.001). Overall, the decrease of GFR was negatively correlated with the initial BMI (r=−0.37, P=0.031).
Conclusion: Despite an alteration of GFR, patients improved their nutritional status with this cooperative follow-up. This is important because the higher the initial BMI the better evolution of GFR (slowly progressing). Moreover a high BMI is known as associated with an improved prognosis in haemodialysed patients (Johansen, Am J Clin Nutr 2004).
01 - 05 Apr 2006
European Society of Endocrinology