1 / 15

QUESTION TIME

QUESTION TIME. La supplementazione proteica nutrizionale è necessaria nel paziente in dialisi peritoneale?. Giuliano Brunori Ospedale Santa Chiara Trento Bari 19 marzo 2009. Supplementi per os (0.1- 0.3 g proteine kg BW/die). pre post p

giulia
Download Presentation

QUESTION TIME

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. QUESTION TIME La supplementazione proteica nutrizionale è necessaria nel paziente in dialisi peritoneale? Giuliano Brunori Ospedale Santa Chiara Trento Bari 19 marzo 2009

  2. Supplementi per os (0.1- 0.3 g proteine kg BW/die) pre post p Protidemia totale (g/dl) 6.20.7 6.70.7 <0.05 Albuminemia (g/dl) 3.460.51 3.820.46 <0.05 BUN (mg/dl) 63.66.3 87.67.5 <0.05 Creatininemia (mg/dl) 10.573.07 11.102.79 <0.05 Colesetrolemia (mg/dl) 18342 20237 NS Trigliceridemia 13668 201104 <0.05 PCR 0.910.20 1.150.22 NR Peso (kg) 52.38.9 54.68.6 NR Shimomura et al. Adv Perit Dial, 1993

  3. CONCLUSIONS: Oral EAAs induce a significant improvement in the serum albumin concentration in hemodialysis but not peritoneal dialysis subjects. Further study of their long-term effects on morbidity and mortality is warranted. Kidney Int. 2000 Jun;57(6):2527-38.

  4. * *Aminess N = 5 compresse/die, contenuto 720 mg per compressa

  5. RCT of oral admministration of egg-albumin based protein supplements* to CAPD Control group (15) Study group (13) p Variable 0 mths 6 mths 0 mths 6mths s. Albumin (g/dl) 2.66±0.6 2.80±0.5 2.64±0.3 3.06±0.7 < 0.05 BUN (mg/dl) 49.7±13 53.9±11 52.6±16 63.3±20 Hb (g/dl) 9.0 (6-11) 8.1 (7-12) 8.2 (7-11) 9.5 (8-10) Chol (mg/dl) 174 181 193 187 Phosphorus (mg/dl) 4.4 (2.8-5.4) 3.5 (2.0-4.8) 6.0 (4.9-7.3) 5.9 (4.2-6.9) < 0.05 *Supplemento: 15 g polvere (aggiunta ai cibi o alle bevande), due volte al giorno Gonzalez_Espinola L et al. Perit Dial Int 2005; 25:173-180

  6. RCT of oral admministration of egg-albumin based protein supplements to CAPD Control group (15) Study group (13) p Variable 0 mths 6 mths 0 mths 6mths Calorie intake (kcal) 1423±410 1567±381 1331±432 1872±698 <0.05 Protein intake (g/kg) 1.0±0.4 1.0±0.3 1.0±0.3 1.7±0.7 <0.05 nPNA (g/kg/day) 0.91±0.11 0.97±0.14 1.0±0.23 1.18±0.35 <0.05 BMI 24.2±3.9 24.5±3.2 22.3±2.7 22.5±3. Gonzalez_Espinola L et al. Perit Dial Int 2005; 25:173-180

  7. SGNA Δ albuminemia RCT of oral admministration of egg-albumin based protein supplements* to CAPD Gonzalez_Espinola L et al. Perit Dial Int 2005; 25:173-180

  8. 118-124 118-124 118-124 157 pts on HD 33 pts on PD 2 lattine al giorno, apporto: 25 g proteine, 500 calorie

  9. - Compensano le perdite di aminoacidi - Compensano l’inadeguato apporto proteico - Migliorano le alterazioni del profilo aminoacidico - Riducono il carico di glucosio - Possono migliorare l’assetto lipidico - Migliorano lo stato nutrizionale (?) - Accentuano l’acidosi Uso soluzioni con aminoacidi

  10. Turnover proteico:pre/post trattamento 16 pazienti; trattamento 21 giorni Metabolismo Proteico (g/kg/die) Peso (kg) Bilancio N Sintesi Catabolismo Bilancio Basale 68.7+11.8 0.022+0.028 2.25+0.59 2.01+0.65 0.24+0.18 Trattamento 69.0+12.0 0.022+0.035 2.49+0.97 2.14+1.00 0.35+0.23 p (B vs T) NS =0.002 NS NS 0.001 JD Kopple et al. Kidney Int 1995, 47:1148

  11. P=0.022 P=NS Protidemia totale e transferrina pre e post trattamento Protidemia Totale, g/dl totale, g/dl Transferrina, mg/dl totale, g/dl /dl , mg/dl , mg/dl P=0.033 P=0.033 P=0.033 P=0.033 P=0.022 P=0.022 P=0.022 P=NS 400 P=NS 400 P=NS 400 8.0 P=NS 8.0 8.0 400 8.0 P=NS P=NS P=NS 200 200 200 4.0 4.0 4.0 200 4.0 0 0 0 0.0 0 0.0 0.0 0.0 giorni 0 16 36 0 16 36 0 16 36 0 16 36 0 16 36 0 16 36 0 16 36 0 16 36 J, 1995 giorni J.D giorni , 1995 giorni from: JD Kopple et al, Kidney Int 1995; 47:1148

  12. Dialysate as food (APD patients) Prestudy End AAG End G Bicarbonate (mmol/L) 22.8±2.2b 24.5±1.7c 26.3±1.0 Urea (mmol/L) 22.7±7.1 21.1±4.1c 21.1±5.0 Phosphate (mmol/L) 2.0±0.4 1.9±0.6d 2.1±0.4 Albumin (g/L) 38±3.0 38±3.0 39±3.0 Net protein balance increase in all 8 pts in AAG period (-0.41±0.16) vs G (-0.62±0.16) (p<0.001) Nitrogen balance change from -0.60±2.38 in G period to 0.35±3.25 in AAG (p<0.061) Tjiong HL et al. JASN 2005; 16:1486-1493

  13. PD e sLPD • RCT a tre diversi livelli di introito proteico: • 1.2 g prot/kg/day (20 pts, 17 compl) • 0.6-0.8 g prot/kg/day (20 pts, 18 compl) • 0.6-0.8 g prot/kg/day + 0.12 g /kg/day di ketoacidi (20 pts, 18 compl) Ipotesi: LPD (sLPD) preserva la funzione renale, senza indurre NB negativo Jiang N et al, Nephrol Dial Transplant 2009; 24:2551-2558

  14. PD e sLPD • a 12 mesi eGFR • sLPD: 3.5 ml/min (t0: 3.9) • LPD: 2.2 ml/min (t0: 4.0) • HP: 2.6 ml/min (t0:4.3) Stabilità in tutti i gruppi dei parametri nutrizionali (albumina, BMI, SGA) nel gruppo sLPD riduzione statisticamente significativa dei livelli di PTH

  15. Conclusione • Dati discordanti • Utile nei pazienti con bassi introiti proteici • Palatabilità dei prodotti • Maggior utilizzo del counseling dietetico? • Utilizzo routinario, in pazienti con intake <0.8 g prot/kg/die di soluzioni contenenti AA? (certezza dell’assunzione) • Ruolo dei ketoacidi?

More Related