• energy wasting
• influencing factors
• intervention
• literature review
• maintenance hemodialysis
• malnutrition
• protein

• Humans
• Renal Dialysis/adverse effects
• Renal Dialysis/methods
• Protein-Energy Malnutrition/etiology
• Protein-Energy Malnutrition/therapy
• Kidney Failure, Chronic/therapy
• Kidney Failure, Chronic/complications
• Quality of Life

• dietary protein
• meta-analysis
• muscle mass
• physical performance
• sarcopenia
• strength

• Northern Ireland Department for the Economy

• Hemodialysis
• Interdialytic nutritional supplements
• Intradialytic nutritional supplementation
• Nutrition status

• Humans
• Renal Dialysis/adverse effects
• Male
• Female
• Malnutrition/etiology
• Malnutrition/therapy
• Middle Aged
• Aged
• Dietary Supplements
• Nutritional Status
• Kidney Failure, Chronic/therapy
• Kidney Failure, Chronic/complications
• Serum Albumin/analysis
• Serum Albumin/metabolism
• Administration, Oral

• Ascorbic Acid
• Dietary supplements
• Inflammation
• Nutritional status
• Renal dialysis
• Vitamin E
• Whey proteins

• Humans
• Ascorbic Acid
• Whey Proteins/therapeutic use
• Interleukin-10
• Interleukin-6
• Pilot Projects
• Dietary Supplements
• Vitamins/therapeutic use
• Renal Dialysis
• Double-Blind Method

• albumin
• chronic kidney disease
• hemodialysis
• nutritional status
• oral nutritional supplements
• peritoneal dialysis

• National Key Research and Development Program of China

• adult
• child
• humans
• dysbiosis
• dysbiosis/complications
• dysbiosis/therapy
• indican
• prebiotics
• probiotics
• probiotics/therapeutic use
• renal insufficiency, chronic
• renal insufficiency, chronic/complications
• renal insufficiency, chronic/therapy
• synbiotics
• uremic toxins

• Adult
• Child
• Humans
• Synbiotics
• Prebiotics
• Dysbiosis/therapy
• Dysbiosis/complications
• Indican
• Uremic Toxins
• Renal Insufficiency, Chronic/therapy
• Renal Insufficiency, Chronic/complications
• Probiotics/therapeutic use

• chronic kidney disease
• glycemic index
• nephropathy
• nutritional supplement
• renal nutrition

• Humans
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/metabolism
• Kidney Failure, Chronic/therapy
• Muscular Atrophy
• Exercise
• Muscles/metabolism

• chronic kidney disease
• hemodialysis
• muscle
• sarcopenia

• Humans
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/metabolism
• Kidney Failure, Chronic/therapy
• Muscular Atrophy
• Exercise
• Muscles/metabolism

• Chronic hemodialysis
• Nutritional markers
• Oral nutritional supplement
• Protein-energy wasting

• hemodialysis
• inflammation biomarkers
• malnutrition
• oral nutritional supplement
• oxidation biomarkers
• probiotics

• Instituto de Salud Carlos III

• dietary intervention
• inflammation
• nutritional status

• Humans
• C-Reactive Protein/metabolism
• Renal Dialysis/methods
• Malnutrition
• Nutritional Status
• Serum Albumin/analysis
• Energy Intake
• Meals
• Kidney Failure, Chronic

• Cohort Studies
• Creatinine
• Humans
• Kidney Failure, Chronic
• Renal Dialysis
• Retrospective Studies

Patients with stages 4 and 5 chronic kidney disease (CKD), and particularly chronic dialysis patients, commonly are found to have substantially reduced daily physical activity in comparison to age- and sex-matched normal adults. This reduction in physical activity is associated with a major decrease in physical exercise capacity and physical performance. The CKD patients are often physically deconditioned, and protein energy wasting (PEW) and frailty are commonly present. These disorders are of major concern because physical dysfunction, muscle atrophy, and reduced muscle strength are associated with poor quality of life and increased morbidity and mortality in CKD and chronic dialysis patients. Many randomized controlled clinical trials indicate that when CKD and chronic dialysis are provided nutritional supplements or undergo exercise training their skeletal muscle mass and exercise capacity often increase. It is not known whether the rise in skeletal muscle mass and exercise capacity associated with nutritional support or exercise training will reduce morbidity or mortality rates. A limitation of these clinical trials is that the sample sizes of the different treatment groups were small. The aim of this review is to discuss the effects of nutrition and exercise on body composition, exercise capacity, and physical functioning in advanced CKD patients.

• Body Composition
• Exercise/physiology
• Exercise Tolerance
• Humans
• Muscular Diseases
• Quality of Life
• Renal Insufficiency, Chronic/therapy

• dialysis
• end-stage kidney disease
• exercise
• meta-analysis
• nutrition
• systematic review
• transplant

• Adult
• Female
• Hand Strength
• Humans
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/therapy
• Male
• Peritoneal Dialysis
• Renal Dialysis/adverse effects
• Sarcopenia/etiology
• Sarcopenia/therapy

Atherosclerosis (AS) is recognized as the original cause of most cardiovascular and cerebrovascular diseases. The dual-protein (DP) nutrition that consists of soy protein and whey protein is reported to be associated with a reduction in AS; however, the relationship between DP and AS remains ambiguous. Therefore, this study aimed to verify the effect of DP on AS and explore the optimal DP intake to improve AS. ApoE^−/− mice were administrated with low- (LDP), middle- (MDP), and high-dose (HDP) DP. The MDP group exhibited significant improvements in AS. In terms of lipid metabolism, the levels of plasma total triglyceride and LDL-C and the mRNA expression levels of Cyp7a1 and PCSK9 were markedly tuned in the MDP group. In addition, the MDP treatment group had a substantially lower inflammatory response and better intestinal barrier function than LDP and HDP groups. The species richness demonstrated by the Chao1 index was distinctly increased in the MDP group, and the relative abundance of intestinal-permeability-protective microbes Blautia and Akkermansia was significantly elevated. In summary, an adequate intake of DP was able to counteract atherosclerosis development in ApoE^−/− mice, and this study provides a scientific theoretical basis for the application of DP in the food and pharmaceutical fields.

• atherosclerosis
• dosage
• dual proteins
• gut microbiota
• lipid metabolism

• Animals
• Apolipoproteins E/genetics
• Atherosclerosis/genetics
• Atherosclerosis/prevention & control
• Diet, High-Fat
• Gastrointestinal Microbiome/physiology
• Mice
• Mice, Inbred C57BL
• Mice, Knockout
• Proprotein Convertase 9

Background: Muscle wasting, observed in patients with end-stage kidney disease and protein energy wasting (PEW), is associated with increased mortality for those on hemodialysis (HD). Oral nutritional supplementation (ONS) and nutrition counseling (NC) are treatment options for PEW but research targeting muscle status, as an outcome metric, is limited.

Aim: We compared the effects of combined treatment (ONS + NC) vs. NC alone on muscle status and nutritional parameters in HD patients with PEW.

Methods: This multi-center randomized, open label-controlled trial, registered under ClinicalTrials.gov (Identifier no. NCT04789031), recruited 56 HD patients identified with PEW using the International Society of Renal Nutrition and Metabolism criteria. Patients were randomly allocated to intervention (ONS + NC, n = 29) and control (NC, n = 27) groups. The ONS + NC received commercial renal-specific ONS providing 475 kcal and 21.7 g of protein daily for 6 months. Both groups also received standard NC during the study period. Differences in quadriceps muscle status assessed using ultrasound (US) imaging, arm muscle area and circumference, bio-impedance spectroscopy (BIS), and handgrip strength (HGS) methods were analyzed using the generalized linear model for repeated measures.

Results: Muscle indices as per US metrics indicated significance (p < 0.001) for group × time interaction only in the ONS + NC group, with increases by 8.3 and 7.7% for quadriceps muscle thickness and 4.5% for cross-sectional area (all p < 0.05). This effect was not observed for arm muscle area and circumference, BIS metrics and HGS in both the groups. ONS + NC compared to NC demonstrated increased dry weight (p = 0.039), mid-thigh girth (p = 0.004), serum prealbumin (p = 0.005), normalized protein catabolic rate (p = 0.025), and dietary intakes (p < 0.001), along with lower malnutrition–inflammation score (MIS) (p = 0.041). At the end of the study, lesser patients in the ONS + NC group were diagnosed with PEW (24.1%, p = 0.008) as they had achieved dietary adequacy with ONS provision.

Conclusion: Combination of ONS with NC was effective in treating PEW and contributed to a gain in the muscle status as assessed by the US, suggesting that the treatment for PEW requires nutritional optimization via ONS.

• hemodialysis
• nutrition counseling
• oral nutritional supplementation
• protein energy wasting
• quadriceps muscle
• ultrasound imaging

The prevalence of sarcopenia increases as renal function decreases, and a considerable number of hemodialysis (HD) patients have sarcopenia. Exercise and nutritional support are established interventions to prevent and treat sarcopenia. Recently, many studies evaluating intradialytic neuromuscular electrical stimulation (NMES) showed improvement of muscular strength and mass, functional capacity, and quality of life (QOL). However, there has been no research about the effect of simultaneous nutritional support and NMES in HD patients.

This is a 12-week, randomized controlled, parallel-group, multicenter trial of intradialytic NMES and protein supplementation for HD patients. Seventy-two patients receiving HD will be randomly assigned in a 1:1:1:1 ratio to control, intradialytic NMES only, protein supplementation only, and intradialytic NMES combined with protein supplementation groups. NMES will be delivered to a total of four areas of the bilateral vastus medialis and vastus lateralis using a 4-channel NMES instrument. A total of 25 g of protein supplements will be provided at the beginning of every dialysis session or after the NMES. The primary endpoint is the difference of hand grip and leg muscle strength at 12 weeks among 4 treatment groups. Secondary endpoints include muscle mass, physical performances, and questionnaires about QOL and physical activity.

In this study, we will evaluate the differential effectiveness of nutritional support and NMES during HD on muscle strength, muscle mass, physical function, and QOL. We expect that this study can provide guidelines for a new therapeutic option for HD patients who are unable or hesitant to exercise. Furthermore, this option can offer an opportunity to improve the physical function, QOL, and prognosis of HD patients.

Clinical Research Information Service (CRIS), Korea, KCT0005573. Retrospectively registered on 03 November 2020

• Hemodialysis
• Muscle strength
• Neuromuscular electrical stimulation
• Physical function
• Protein supplementation
• Quality of life

• Cardiovascular mortality
• Cohort study
• Dietary protein intake
• Hemodialysis
• Mortality

• Exercise
• Hand grip strength
• Hemodialysis
• Leg muscle strength

• Adiponectin
• Adult
• Humans
• Leptin
• Randomized Controlled Trials as Topic

• Exercise
• Kidney replacement therapy
• Preventive medicine
• Rehabilitation
• SARS-CoV-2

• Fundação de Apoio à Pesquisa do Distrito Federal

• chronic kidney disease
• energy
• enteral nutrition
• nutrition requirements
• nutrition support
• parenteral nutrition
• protein

Although animal protein is usually considered to be a more potent stimulator of muscle protein synthesis than plant protein, the effect of protein source on lean mass and muscle strength needs to be systematically reviewed. This study aimed to examine potential differences in the effect of animal vs. plant protein on lean mass and muscle strength, and the possible influence of resistance exercise training (RET) and age. The following databases were searched: PubMed, Embase, Scopus and CINAHL Plus with Full Text, and 3081 articles were screened. A total of 18 articles were selected for systematic review, of which, 16 were used for meta-analysis. Total protein intakes were generally above the recommended dietary allowance at the baseline and end of intervention. Results from the meta-analyses demonstrated that protein source did not affect changes in absolute lean mass or muscle strength. However, there was a favoring effect of animal protein on percent lean mass. RET had no influence on the results, while younger adults (<50 years) were found to gain absolute and percent lean mass with animal protein intake (weighted mean difference (WMD), 0.41 kg; 95% confidence interval (CI) 0.08 to 0.74; WMD 0.50%; 95% CI 0.00 to 1.01). Collectively, animal protein tends to be more beneficial for lean mass than plant protein, especially in younger adults.

• body composition
• muscle mass
• muscular strength
• protein source

• Chronic disease
• cytokines
• functional foods
• immune system
• inflammation
• nutrients

• Maintenance hemodialysis
• Nutrition status
• Renal-specific oral nutrition
• Serum albumin

The identification of malnutrition-inflammation-complex (MIC) and functional status (FS) is key to improving patient experience on hemodialysis (HD). We investigate the association of MIC and FS combinations with mortality in HD patients. We analyzed data from 5630 HD patients from 9 countries in DOPPS phases 4–5 (2009–2015) with a median follow-up of 23 [IQR 11, 31] months. MIC was defined as serum albumin < 3.8 g/dL and serum C-reactive protein > 3 mg/L in Japan and > 10 mg/L elsewhere. FS score was defined as the sum of scores from the Katz Index of Independence in Activities of Daily Living and the Lawton-Brody Instrumental Activities of Daily Living Scale. We investigated the association between combinations of MIC (+/−) and FS (low [< 11]/high [≥ 11]) with death. Compared to the reference group (MIC−/high FS), the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.82 (1.49, 2.21) for MIC−/low FS, 1.57 (1.30, 1.89) for MIC+/high FS, and 3.44 (2.80, 4.23) for MIC+/low FS groups. Similar associations were observed with CVD-related and infection-related mortality. The combination of MIC and low FS is a strong predictor of mortality in HD patients. Identification of MIC and poor FS may direct interventions to lessen adverse clinical outcomes in the HD setting.

• Inflammation
• Interleukin-6
• Isoflavone
• Meta-analysis
• Soy
• TNF-α

• dialysis
• meta-analysis
• muscle fitness
• muscle mass
• muscle strength
• nursing
• oral nutritional supplement
• physical performance
• sarcopenia
• systematic review

• CRP
• Genistein
• Inflammation
• Meta-analysis
• Soy
• Systematic review

• Biomarkers/blood
• C-Reactive Protein/metabolism
• Dietary Supplements
• Humans
• Inflammation/blood
• Inflammation/therapy
• Interleukin-6/blood
• Randomized Controlled Trials as Topic
• Glycine max
• Tumor Necrosis Factor-alpha/blood

• Haemodialysis
• Malnutrition
• Protein supplementation
• Protein-energy wasting (PEW)
• Serum albumin

This study aimed to develop two non-industrial food products as financially accessible options to prevent and treat malnutrition in hemodialysis (HD) patients. These food products were developed and intended for use as dialysis snacks.

This is a cross-sectional and multi-step study. First, 183 adult HD patients (55 ± 14 years; 50.8% males), replied to a questionnaire with their food preferences regarding taste (salty, sweet, bitter, sour) and consistency (liquid, solid, pasty) for a dialysis snack. Most patients preferred a food product with a solid consistency (90%) and a salty flavor (81.4%). Second, three muffin formulations of fine herbs were developed; one enriched with whey protein concentrate (WPC), a second with textured soy protein (TSP) and a third standard formulation without protein for comparison with the protein-enriched muffins, for which the chemical and nutritional compositions were analyzed. In the third step, 60 patients on HD (61 ± 15 years; 53% males) were enrolled in a sensory analysis by applying a 9-point structured hedonic scale, ranging from “extremely liked” (score 9) to “extremely disliked” (score 1).

When compared with the standard formulation, the formulations enriched with WPC and TSP protein had a significantly higher amount of protein/serving (Standard: 5.9 ± 0.3 g vs WPC: 14.5 ± 0.9 g and TSP 10.8 ± 0.7 g; P < 0.05) but a lower amount of carbohydrate (Standard: 13.1 ± 2.2 g vs WPC: 5.6 ± 0.8 g and TSP 6.0 ± 1.2 g vs; P < 0.05). The mineral content/serving of the protein-enriched muffins was low in phosphorus (50 mg) and sodium (180 mg). The potassium content/serving was moderate for the WPC muffin (225.2 mg) and low for the TSP muffin (107.9 mg). The acceptability index (AI) for the enriched protein muffins was higher than 70% and similar to the standard formulation.

The muffins with fine herbs and enriched with protein were well-accepted by all patients and appropriate to serve as dialysis snacks for HD patients.

• Dialysis snack
• Energy protein supplement
• Hemodialysis
• Protein energy wasting

With the unprecedented growth of mobile technology, a plethora of dialysis diet apps have been developed to promote patient dietary self-management. Nevertheless, the utility of such apps remains questionable.

This study aimed to evaluate the content, features, and quality of commercial dialysis diet apps for adult dialysis patients.

This study consisted of a quantitative content analysis of commercial dialysis diet apps downloaded from Google Play and the Apple App Store available in the Asian marketplace, searched for using the following keywords in English: dialysis diet and diet for kidney disease. Free and paid apps available in English that provide nutrition information for adult dialysis patients were included. Apps that were not relevant to the dialysis diet, not meant for patient self-management, or redundant were excluded. Apps were evaluated for language medium (subscore=1), credibility (subscore=1), food database (subscore=1), valuable features (subscore=12), health-behavior theory constructs (subscore=60), and technical quality (subscore=25). The relationships among the variables of interest were determined by Pearson correlation. Stepwise multiple linear regression analysis was performed to identify the features that contribute to greater technical quality of dialysis diet apps. Statistical significance was defined as P<.05.

A total of 22 out of 253 apps (8.7%) were eligible for evaluation. Based on a 100-point scale, the mean overall score of the apps was 31.30 (SD 14.28). Only 5% (1/22) of the apps offered relevant language options, and 46% (10/22) contained food databases. In addition, 54% (12/22) of the apps were not credible. The mean score for valuable features was 3.45 (SD 1.63) out of 12, in which general education (16/22, 73%), free download (15/22, 68%), and usability (13/22, 59%) were the three most popular features. However, the apps scored a mean of 13.41 (SD 11.56) out of 60 for health-behavior theory constructs. The overall app technical quality was considered poor, with a mean score of 2.70 (SD 0.41) out of 5. The scores of valuable features (r=.65, P=.001) and health-behavior theory constructs (r=.55, P=.009) were positively correlated with the overall technical quality of the commercial dialysis diet apps. Features such as free download (β=.43, P=.03) and usability (β=.41, P=.03) could significantly determine the functional quality of the apps. Health-behavior theory constructs such as self-monitoring could significantly predict both the subjective quality (β=.55, P=.008) and the engagement quality (β=.66, P=.001) of the apps, whereas the information quality domain could be determined by plan or orders (β=.48, P=.007) and knowledge (β=.45, P=.01).

Although most of the available commercial dialysis diet apps are free and easy to use, they are subject to theory deficiency, limited language options, and a lack of food databases, credibility, tailored education, and overall technical quality.

• dialysis
• mHealth
• nutrition
• renal apps
• self-management

• Administration, Oral
• Arm/anatomy & histology
• Bias
• Biomarkers/blood
• Dietary Proteins/administration & dosage
• Dietary Proteins/adverse effects
• Humans
• Malnutrition/blood
• Malnutrition/etiology
• Malnutrition/therapy
• Peritoneal Dialysis/statistics & numerical data
• Placebos/administration & dosage
• Prealbumin/metabolism
• Quality of Life
• Randomized Controlled Trials as Topic
• Renal Dialysis/statistics & numerical data
• Renal Insufficiency, Chronic/blood
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/therapy
• Serum Albumin/metabolism
• Skinfold Thickness

• exercise
• kidney disease
• muscle wasting
• nutrition

• Dietary Proteins/administration & dosage
• Exercise/physiology
• Humans
• Kidney Failure, Chronic/physiopathology
• Kidney Failure, Chronic/therapy
• Muscle Proteins/metabolism
• Muscle, Skeletal/physiopathology
• Nutritional Requirements
• Renal Dialysis

• 2017 NUTRIM NWO Graduate Programme

• Intradialytic resistance exercise
• Maintenance hemodialysis
• Sarcopenia
• Systemic inflammation

• Adult
• Aged
• Exercise
• Female
• Humans
• Inflammation/complications
• Inflammation/physiopathology
• Inflammation/therapy
• Male
• Middle Aged
• Renal Dialysis
• Resistance Training
• Sarcopenia/complications
• Sarcopenia/physiopathology
• Sarcopenia/therapy

• arterial stiffness
• exercise
• hemodialysis
• nutrition
• physical function

This systematic review aims to determine the potential effects of oral nutritional supplements (ONS) in patients receiving maintenance dialysis therapy (MDT).

Electronic databases were searched without language limits through to July 2018. Randomized controlled trials (RCTs) that involved comparisons of ONS versus placebo or routine care are included in this meta-analysis. RevMan 5.3 statistical software was used for meta-analysis.

15 articles with 589 subjects were included in our study. There are insufficient comparable data of randomized trials to allow meta-analysis of mortality. Albumin levels may be improved by the macronutrient blends or protein/amino acid supplements in MDT patients. Compared with the control group, serum albumin levels and BMI in the ONS group were increased by 1.58 g/L (95% CI, 0.52–2.63, P = 0.003; I² = 85%) and 0.40 kg/m² (95% CI, 0.10–0.71, P = 0.01; I² = 49%), respectively. In the subgroup analysis of patients receiving hemodialysis, albumin levels in ONS group were increased by 2.17 g/L (95% CI, 0.89–3.45, P<0.001; I² = 90%). ONS may not influence serum phosphorus and potassium levels.

Very low-quality evidence suggests that Short-term oral energy or protein/amino acid supplements may improve nutritional status by increasing serum albumin levels and BMI in MDT patients, without influence on serum potassium levels. High-quality and large RCTs, particularly regarding the effects of ONS on mortality and quality of life, are needed to further validate our findings.

• Body Mass Index
• Databases, Factual
• Dietary Supplements
• Humans
• Kidney Failure, Chronic/pathology
• Kidney Failure, Chronic/therapy
• Nutritional Status
• Quality of Life
• Randomized Controlled Trials as Topic
• Renal Dialysis
• Serum Albumin/analysis

• antioxidants
• fibres
• haemodialysis
• inflammation
• meta-analysis
• nutrition
• omega-3 fatty acids
• polyphenols
• systematic review

• Adult
• Aged
• Antioxidants/administration & dosage
• Biomarkers/blood
• Dietary Fiber/administration & dosage
• Dietary Supplements/adverse effects
• Fatty Acids, Omega-6/administration & dosage
• Fatty Acids, Omega-6/adverse effects
• Female
• Humans
• Inflammation/blood
• Inflammation/diagnosis
• Inflammation/diet therapy
• Inflammation/etiology
• Inflammation Mediators/blood
• Male
• Middle Aged
• Nutritional Status
• Probiotics/administration & dosage
• Renal Dialysis/adverse effects
• Treatment Outcome
• Vitamin D/administration & dosage
• Vitamin E/administration & dosage
• Vitamin E/adverse effects