The effect of nocturnal haemodialysis on body composition karin ipema dietician researcher
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The effect of Nocturnal Haemodialysis on Body Composition Karin Ipema, dietician/researcher, Dialysis Center Groningen In cooperation with Hanze University Groningen , Professorship in Health Care and Nursing. 1 September 2013. Background.

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The effect of Nocturnal Haemodialysis on Body Composition Karin Ipema, dietician/researcher,

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The effect of nocturnal haemodialysis on body composition karin ipema dietician researcher

The effect of Nocturnal Haemodialysis on Body Composition

Karin Ipema, dietician/researcher,

Dialysis Center Groningen

In cooperation with HanzeUniversity Groningen, Professorship in Health Care and Nursing

1 September 2013


Background

Background

  • 20 -70% Malnutrition and poor physical functioning in dialysis patients

  • Decline in muscle and fat tissue

  • Nocturnal HD:

    • Increase in protein intake

    • More free time

    • Improving Quality of life


Study question

Study Question

Is the transition from conventional HD to nocturnal HD after 1 year associated with an increase in fat and/or fat-free mass?


Patients

Patients

  • Research group: Nocturnal haemodialysis patients (±4-6 x pw 8 hours dialysis)

    • Nocturnal In-centre Haemodialysis – every other night 8 hrs dialysis

    • Nocturnal Home Haemodialysis– 5-6 night pw 8 hrs dialysis

  • Control group: Conventional Haemodialysis, matched on gender, age, and dialysis vintage (±3 x pw 4 hrs dialysis)


Inclusion and exclusion criteria

Inclusion and exclusion criteria

  • Inclusion criteria: chronic haemodialysis patients, aged >18 years who were scheduled to start on NHD

  • Exclusion criteria: short life expectancy (<1 year), a substantial amount of metal in the body, absence of informed consent


Method

Method

  • DEXA-scan Whole body composition

  • DEXA-scan shortly after the dialysis session

CHD

Nocturnal HD

CHD

Conventional HD

Dexa 1

Dexa 2


Dexa scan

DEXA scan


Method1

Method

Study design:

  • DEXA-scan Whole body composition

  • DEXA-scan shortly after the dialysis session

  • Laboratoy measurements: albumin, nPCR, e.g.

  • Statistical analysis with Linear mixed models


Results

Results

Patient characteristics:

  • Recruitment period of 3 years

  • 21 patients included in the research group, 10 patients did not complete the first year of NHD, :

    • N=2: difficulty with sleeping

    • N=7: severe intercurrent sickness (sepsis, hart failure with low blood pressures)

    • N=1: kidney transplantation


Results1

Results

Nocturnal haemodialysis

Conventional haemodialysis

N=13

8 male / 5 female

Years on dialysis: 3.7 (1-11)

DM: 2 persons

BMI 25.8 kg/m2 (±3.9)

  • N=11 - 6 NHHD / 5 NCHD

  • 6 male / 5 female

  • Years on dialysis: 4.7 (1-15)

  • DM: 1 person

  • BMI 24.7 kg/m2 (±3.7)


Results protein intake albumin

Results Protein intake & Albumin

Effect size interaction: +0.23 g/kg/day

(P= 0.027)

No significant difference


Results body composition

Results Body Composition

No significant difference

No significant difference

No significant difference


Results covariates

Results Covariates

Co-variates:

  • Gender

  • Age

  • Dialysis vintage

    Dialyse vintage shows a negative effect on the fat mass,

    total mass, and BMI:

  • Fat mass: -1.48 kg per year (P=0,010)

  • Total mass: -1.65 kg per year (P=0,018)

  • BMI: -0.6 kg/m2 per year (P=0,011)


Conclusion

Conclusion

In this study we observed a significant increase in protein intake after the transition from CHD to NHD.

One year of nocturnal haemodialysis had no significant effect on body composition in comparison with CHD patients, despite a higher protein intake.

In this relatively small study, a longer dialysis vintage had a negative effect on fat mass and BMI. Dialysis vintage seems to have more effect on the body composition than the form of haemodialysis.


Questions

Questions

Tack förattnilyssnade

Vi ses i Groningen

Karin J.R. Ipema1,2, Ralf Westerhuis1,3, Cees P. van der Schans2,4, Paul E. de Jong3, Wim P. Krijnen2, Riemer H.J.A. Slart5, and Casper F.M. Franssen3

1Dialysis Center Groningen, 2Professorship in Health Care and Nursing – Hanze University Groningen, University of Applied Sciences, 3Department of Internal Medicine, Division of Nephrology,University Medical Center Groningen, 4Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, The Netherlands, 5Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands


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