Life Sciences Commons^™

Nutrition And Health Status Of Hemodialysis Patients In Dhaka, Bangladesh, Tanjina Rahman

Wayne State University Dissertations

Methods to identify patients at risk for End stage renal disease (ESRD) are a high priority in Bangladesh, where kidney transplants/dialysis options are limited and costly. Every year, 35,000 to 40,000 people reach ESRD in Bangladesh, but currently available facilities can hardly accommodate only 9000 to 10,000 new patients with twice weekly dialysis and the remaining 66% have no access to any kind of renal replacement therapy (RRT) in the form of dialysis or transplantation. Nutrition is an important factor in maintaining good health of hemodialysis patients. However, data on nutritional status of Bangladeshi dialysis patients is limited and is …

Impact Of Dietary Patterns On Health Outcomes In African American Maintenance Hemodialysis Patients, Dina Angela Tallman

Wayne State University Dissertations

In the United States, African Americans (AA) suffer a disproportionate burden of ESRD, accounting for 35% of all dialysis patients, and are 3.7 times more likely to progress to ESRD than whites. This increase in CKD risk is partially attributed to higher rates of hypertension, diabetes mellitus, and cardiovascular disease. Paradoxically, once on hemodialysis, AA have a survival advantage over whites, likely due to multiple factors including nutritional status, inflammation, psychosocial status, and genetic variation.

Although both the dialysis procedure and pharmacological treatments are effective at reducing the uremic toxin load, HD patients are still encouraged to adhere to strict …

Relationships Of Dietary Protein And Phosphorus With Protein Energy Wasting In Hemodialysis Patients, Dina Angela Tallman

Wayne State University Theses

Both higher dietary phosphorus intake and a greater dietary phosphorus to protein ratio are associated with increased death risk in hemodialysis (HD) patients even after adjustments for serum phosphorus, type of phosphate binder used, and dietary protein, energy, and potassium intake. Furthermore, dietary phosphorus restriction to control serum phosphorus is often associated with a reduction in protein intake, which is associated with muscle wasting and poor survival. One highly prevalent complication of end stage renal disease is protein energy wasting (PEW), a state of decreased body protein and fat mass, which is strongly associated with increased morbidity and mortality in …

Effects Of Statin Drugs And Tocotrienol Rich Fraction Supplementation In Chronic Hemodialysis Patients And Metabolomic Profile, Eno Latifi

Wayne State University Theses

Chronic kidney disease (CKD) is known as a heterogeneous disorder which currently is on the rise and lately has been classified as a public health issues in the United State and worldwide. CKD is an irreversible and progressive disease which can lead to kidney failure, and this is depicted by the advanced stage of the disorder when it reaches the point, that is classified as end stage of renal disease (ESRD) (Stage 5 of CKD) (eGRF <15 mL/min/ 1.73 m2 working capacity), where both organs are in a total or permanent kidney failure. End-Stage renal disease patients, on hemodialysis have been associated to experience an accelerated form of atherosclerosis, which is induced by inflammation, impairment of antioxidant system and elevated oxidative stress. Since the problem effecting ESRD patients is multifactorial, the objective of this investigation is to explore and look at the effects of supplementing with vitamin E-tocotrienol rich fraction (TRF), a micronutrient which has anti-inflammatory, antioxidant, and lipid lower capabilities into tackling these comorbid conditions experienced by this population. Therefore the aims of this investigation will be to explore changes in lipid profiles, inflammatory markers, and oxidative status, as well as look at any changes in metabolomic profiles. It was hypothesized that by supplementing with TRF a vitamin E, for 16 weeks in ESRD patients undergoing hemodialysis, it may help reverse and/or improve, oxidative status, inflammatory markers, increase antioxidants status and improve lipid profiles.

The study was double-blinded, randomized, parallel, placebo-controlled design trial, of 81 adult patients undergoing chronic hemodialysis at Great Lake Dialysis Clinic, Detroit MI, where …

Multifaceted Nutritional Intervention In Hemodialysis Patients, Zulfitri Azuan Mat Daud

Wayne State University Dissertations

Mortality rate in patients undergoing chronic hemodialysis (HD) in the United States remain unacceptably high despite improvement in dialysis technology. Cardiovascular disease (CVD) account for more than 50% of the premature death in this population. Evidences indicate that the accelerated CVD are attributed to by malnutrition, inflammation, dyslipidemia and oxidative stress. Dietary intervention using nutrients with antioxidant, anti-inflammatory, and potential lipid altering properties to correct the aforementioned problems remain inconclusive. Furthermore, such nutritional intervention trial is often hampered by poor compliance related to medical and socioeconomic barriers. Therefore, a series of randomized, double-blind, placebo-controlled, parallel trials were undertaken to document …

Effects Of Tocotrienol Rich Fractions On Lipid Profiles In Hemodialysis Patients, Rami Hanna

Wayne State University Theses

Chronic hemodialysis (HD) patients have an increased risk of cardio vascular diseases (CVD) driven by dyslipidemia, oxidative stress and inflammation. Vitamin E isomers (tochopherols and tocotrienols) are fat-soluble anti oxidants. Tocotrienol isomers (T3) are fewer studies than tochopherol isomers, but they have multifaceted effects on oxidative stress, inflammation and lipid metabolism. We investigated the lipid modifying effects of tocotrienol rich fractions (TRF) on CKD patients receiving HD in a randomized, placebo-controlled, double-blind parallel trial on 81 patients (43M, 38F). Subjects (n=41) were given 220 mg/day of either TRF (180mg TRF, comprising of 34% áT3, 3%âT3, 50% ãT3, 13%äT3 and 40 …

Nutritional Status In A Cohort Of Hemodialysis Patients Receiving Tocotrienol Supplementation, Rajeev Shahani

Wayne State University Theses

Kidney disease is defined by a loss of kidney function over time [1]. It is expressed in terms of glomerular filtration rate at five stages calculated by the MDRD formula [5]. The fifth stage (<15 mL/min/1.73m2) is designed as end stage renal disease requiring renal replacement therapy in the form of hemodialysis [5]. This requires the use of an artificial kidney (dialyzer) to filter out by-products from the blood for excretion [8]. The issue arises when toxin accumulation due to decreased renal function, dialytic factors such as incompatible dialyzer membranes reacting with blood, and co-morbid conditions such as infection or diabetes mellitus [3]. This increases inflammation within the body, leading to a negative nutrient/energy balance, resulting in a loss of body mass thereby increasing the mortality risk [10]. Tocotrienols (T3), a more potent and underutilized form of Vitamin E, are being administered to attenuate this increase in inflammation via supplementation in addition to food intake. In order to attend to this issue, the nutritional status was assessed utilizing three measures: examining nutrient intake profiles (while supplementation was taken into consideration), obtaining anthropometric findings of body mass index, and analyzing biochemical profiles of serum albumin and pro-inflammatory markers (i.e. IL-6). This data was obtained via a randomized, double blind, placebo-controlled study of 81 dialysis patients. At two times over the course of 16 weeks, blood collection for serum albumin and inflammatory markers was analyzed and dietary intake was assessed using 24-hour diet recalls and Nutritionist Pro software. Statistical analyses of paired t-tests and correlation studies revealed no significant differences between the two groups later showing no noticeable effect of T3 supplementation. Reasoning may be multifactorial such as underestimation of food intake, transcription of diet recalls may not be truly representative, or T3 supplements may not have had an effect on the nutritional statuses. It may be beneficial for patients to receive more extensive nutritional counseling as opposed to nutritional supplementation to ensure compliancy with recommended intakes.