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Article Dans Une Revue Nephrology Année : 2016

Hemodialysis patients with diabetes eat less than those without: a plea for a permissive diet

Julien Astier
  • Fonction : Auteur
Sylvie Cado
  • Fonction : Auteur
Jérôme Sallette
  • Fonction : Auteur
Jérôme Sampol
  • Fonction : Auteur
Hélène Sichez
  • Fonction : Auteur
Jacques Ollier
  • Fonction : Auteur
Jean Gugliotta
  • Fonction : Auteur
Marianne Serveaux
  • Fonction : Auteur
Julien Cohen
  • Fonction : Auteur

Résumé

The main cause of malnutrition in hemodialysis patients is a spontaneous decline in energy and protein intakes. This study aims to report the dietary energy intake (DEI), dietary protein intake (DPI), and dietary micronutrient intake in a French HD population, to report factors associated with a low DPI and DEI, and to analyze if nutritional intake was correlated with nutritional status.
We conducted an observational cross-sectional study in a hemodialysis population of 87 adult patients in July 2014. Daily nutritional oral intake, handgrip strength, body composition measured by bioimpedancemetry, and biological and dialysis parameters were obtained from medical records. Statistical analyses of parameters associated with DEI and DPI were performed.
The median age (interquartile range) of the population was 77.3[71.1; 84.8] years, 57.5% were men, and 52.9% had diabetes mellitus. Median weight-adjusted DEI was 18.4[15.7;22.3]kcal/kg/day (1308 [1078; 1569] kcal/day), and median weight-adjusted DPI was 0.80[0.66; 0.96] g/kg/day (57.5[47.1; 66.8] g/day). In multivariate analysis, weight-adjusted DEI was statistically lower in patients with diabetes (coefficient [95%CI] -3.81[-5.21;-2.41] kcal/kg/day; p = 0.01) but was not associated with the others parameters. When DEI was not adjusted for weight, diabetes was no longer associated with DEI, but female gender (-178[-259;-961] kcal/day; p = 0.03) and a higher Charlson comorbidity index (-30[-44;-15]; p = 0.04) were associated with a lower calorie intake. Results for DPI were similar except that the Charlson comorbidity index did not reach significance.
Diabetes is an important factor associated with low dietary intake in hemodialysis patients. Restrictive regimens should be prescribed cautiously in hemodialysis patients, especially in those with diabetes.
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Dates et versions

hal-01478314 , version 1 (26-09-2017)

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Stanislas Bataille, Jean Landrier, Julien Astier, Sylvie Cado, Jérôme Sallette, et al.. Hemodialysis patients with diabetes eat less than those without: a plea for a permissive diet. Nephrology, 2016, 22 (9), ⟨10.1111/nep.12837⟩. ⟨hal-01478314⟩
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