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  • Title: Clinical and dietary indicators associated with uremic status in hospitalized dialysis patients.
    Author: Steiber AL, Weatherspoon LJ, Handu D.
    Journal: J Ren Nutr; 2002 Jan; 12(1):49-54. PubMed ID: 11823994.
    Abstract:
    OBJECTIVE: The objective of this study was to determine whether any differences existed between specific admission variables and uremic status in patients with chronic renal failure receiving dialysis. DESIGN AND SETTING: This was a prospective, observational study conducted at BryanLGH Medical Center East Campus in Lincoln, Nebraska. PATIENTS: The subjects were hemodialysis and peritoneal dialysis patients admitted to an acute care facility, who met the following inclusion criteria: (1) they had a primary or secondary underlying diagnosis of chronic renal failure, and (2) they were not receiving parenteral or enteral tube feeding nutritional support on admission. INTERVENTION: The patients were separated into 2 groups by their blood urea nitrogen (BUN) concentrations. Group 1 had a BUN concentration less than 50 and group 2 had a BUN concentration greater than or equal to 50. Admission data (age, sex, percentage of ideal body weight, reported retrospective weight loss over time, type of dialysis, gastrointestinal history, BUN and creatinine concentrations, and dietary prescription) were collected from patient medical records. Two-day kilocalorie and protein counts were conducted on the patients within 24 hours of admission to the acute care facility. Chi-square and 1-way analysis of variance were performed to compare the groups. RESULTS: The total number of participants in the study was 42, with 21 in each BUN group. The mean age was 60 years, and the dietary intake was a mean of 10 kcal/kg and 0.4 g protein/kg. Only 14.3% and 7.1% of the patients met their kcal and protein needs, respectively. The mean percentage ideal body weight was 125 and the mean reported weight loss per week was 2.6 pounds. Gastrointestinal symptoms, specifically nausea and a kilocalorie-restricted diet prescription, were significantly different between the 2 groups. Patients in group 2 were more likely to have gastrointestinal symptoms overall (P < .05) specifically, nausea (P <.05). Group 1 patients were also more frequently placed on a kilocalorie-restricted diet (P < .05) than patients in group 2. CONCLUSIONS: A BUN concentration between 50 and 110 has been shown to be associated with a lower risk of death and a better nutritional status. These findings indicate symptoms commonly associated with uremia, such as nausea, may be associated with the dialysis patient's nutritional status when BUN concentrations are greater than 50. These dialysis patients were not receiving sufficient kilocalories and protein on admission into the hospital, and this can affect their nutritional and, eventually, survival status.
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