Validation of serum transthyretin (prealbumin) as a nutritional parameter in hemodialysis patients

1997 CRN Annual A STUDY ON 06/03 AND P/M/S RATIOS OF FATTY ACIDS IN STABLE-HEMODIALYSIS PATIENTS. Cheonnmin Cha, Misun Park, Younghee Lee. Seoul National University Hospital, Seoul, Korea. Diet high in saturated fat and unbalanced ratio of polyunsaturated/saturated fatty acid are associated with increased incidence of artherosclerosis and coronary heart disease. Because of the high risk of atherosclerotic vascular disease in Hemodialysis patients, dietary control of fatty acid intake is required. The purpose of this study was to estimate the w6/03 and P/M/S ratios of fatty acids m stable-hemcdtalysis patients and eventually contribute to establish the dietary guidelines of fatty acids for the Korean hemodialysis patients. Thirty-one patients with end-stage renal disease receiving hemodialysis therapy at the Seoul National University Hospital were recruited for this study. Each patient dietary intake was assessed twice by means of a 24-hour dietary recall method by a trained and certified registered dietitian. Blood samples were collected to measure the concentration of serum total triglyceride, total cholesterol and HDL and LDL-cholesterol. The mean caloric intake was 16’29 +_ 43 kcakd, and the mean protein intake was 55.81 f 16.2 g/d (0.9 + 0.3 g/kg dry body weight). The fat intake was 26 % of total kilocalorie and saturated fat was 4.3 % of total kilocalorie intake. The ratio of polyunsaturated/ monounsaturat&saturated fatty acids and 06/@3 were l.YVO.8 and LO/l, respectively. The concentration of serum total triglyceride, total cholesterol, HDL-cholesterol and LDL-cholesterol were 126 n&l, 174.89 mg/dl, 33.39 m&l. and 113.58 mg/dl, respechvely. All lipid profiles were in normal ranges, and 06/03 and P/M/S ratios of fatty acids seems to fall m the desirable range. However percentage of fat intake of total calories was higher than the recommend guidelines (Korean Recommendation guideline IS 20% of total calories) and the protein intake is only 0.9 g/kg/d. Therefore a careful control was required to reduce the total fat intake and to mcrease the protein mtake for hernodialysis patients. VALIDATION OF SERUM TRANSTHYRETIN (PREALBUMIN) AS A NUTRITIONAL PARAMETER IN HEMODIALYSIS PATIENTS. Annmane Duggan MSRD, Fatma G. Huffman RD, PhD, Complete Dralysls Care, Inc , Coral Springs, Flonda and Flonda Infernational University, Miamr, Florida The vahdrty of serum transthyretm (prealbumm) as a nutntron assessment parameter was mveshgated m pabents recerving chronic hemodlalysls Fifty-one patrents (39% male and 61% female, 53% black, 28% white, 12% Hrspanic, 7% other) who had recerved maintenance hemodralysis for 30 +24 months (meanlSD) and a total of 3&26 months of renal replacement therapy were followed for SIX months. The primary etiologies of end stage renal drsease were drabetic nephropathy (37%), hypertensrve nephrosclerosis (37%). glomerulonephntis (12%) polycystrc kidney drsease (4%) lupus nephritis (4%) other causss (6%) Serum transthyretm, elbumrn, BUN, creattnrne, cholesterol, normahzed pmtein catabolic rate (nPCR), KTN, weight and 24 hour urine analysrs were measured for SIX months The overal mean transthyretm level was 32 mg/dl i 7 for the SIX month study period. Thirty six percent of patrents had mean transthyretm levels ~30 mg/dl Transthyretin levels 240 cc/24 hours, predralysis BUN < 50 mg/dl and nPCR ~0 8 gmlkglday (p3 5 amIdI The detectron of’law transthyretin levels In patrents &th norma albumm levels may rdenbfy those at risk for malnutntlon Transthyretm levels were consrstently lower m diabetics for all SIX months (srgnificant in two/srx months) No srgnificant correlahon was found between transthyretm and age, gender, race, body mass Index, months of hemodralysrs, cholesterol or KTN Measunng serial serum transthyretin levels in hemodialysis patients IS a rehable method for identifymg patrdnts rn need of nutntlon mtewention

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Abstracts

PYRlPOXAL PHOSPHATEIS, EVALUATION OF STATUS IN HEMODIALYSIS (HD) PATIENTS AND THE CLINICAL INDICATORS ASSOCIATED WITH POSITIVE AND NEGATIVE DEVIANCE. Kelfv MP. Kight MA, Don BR, Casbllo ST, Mrgkore VT Urnvererty of Cakfornta Renal Center, San Francraco, CA Plasma pytidoxal phosphate (PPP) status was assessed by The purpose of radroenzymatic asaaytn thnty-seven HD patrents the study was to (1) pan nutrient status with altered body oomposibon findings on Nutntron Physical Examinabon (NPE); (2) document nutrient-based lessons with macrophotography: and (3) characterizeclinical mdfcators associated wrth risk usmg Student’s r tests and/or Pearson’s correlational coefftcrents. Mean + SEM PPP was 33 0 + 5 8 ng/mL (R 3 6-I 6 0) Mean 15.8 + 3 1 age of the sample was52 2 f 2 6 yrs wtth HD duration months Marked Posftrve and Negative Deviance was observed wrth 46% of the values greater than laboratory normal range and 19% leaa than the lab range. NPE findings m deficiency included (1) reddened tongue, (2) frkform paprllary atrophy, (3) fillform papllary hypartrophy, and (4) seborrherc-kke dermatitis PPP correlated strongly wrth albumm (ALB) (r = .4202: p < 0.01); but drd not correlate with age, HD duration, KtN, PCR, thramm. riboflavm, nlacm, B,,, folate, or zinc PPP” (mean + SD) escalated srgnificantly m subgroups supplemented with Be (1) No Vote. No B, (2) Renal Vote Only (3) 26-50maB,

N=12 N=14 N=ll

‘84+/-85 ‘24.5+/-21 *707+/-364

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