RESUMEN
BACKGROUND: Current treatment for chronic kidney disease (CKD) focuses on improving manifestations and delaying progression. Nutritional approaches play a crucial role in CKD management, and various supplements have become available. Ketoanalogues of amino acids (KAs), calcium citrate, and inulin have been proposed as suitable supplements, yet their widespread use has been limited due to insufficient evidence. This study aimed to generate general guidance statements on the appropriateness of these supplements through a RAND/UCLA consensus process. METHODS: A RAND/UCLA consensus panel was convened to evaluate the appropriateness of these supplements in different clinical scenarios. In this study, we present a subgroup analysis focusing on a panel of eleven clinical nephrologists from among the experts. RESULTS: Supplementation of low-protein diets (LPDs) and very low-protein diets (VLPDs) with KA was considered appropriate to reduce manifestations and delay CKD outcomes, supplementation with calcium citrate is considered appropriate to reduce CKD manifestations, and supplementation with inulin is considered appropriate to delay CKD outcomes and manage comorbidities. CONCLUSIONS: Based on a combination of clinical experience and scientific evidence, the panel reached a consensus that KA supplementation of LPD and VLPD, calcium citrate, and inulin are appropriate in patients with CKD across various scenarios.
Asunto(s)
Aminoácidos , Citrato de Calcio , Consenso , Dieta con Restricción de Proteínas , Suplementos Dietéticos , Inulina , Insuficiencia Renal Crónica , Insuficiencia Renal Crónica/dietoterapia , Humanos , Inulina/administración & dosificación , Aminoácidos/administración & dosificación , Dieta con Restricción de Proteínas/métodos , Citrato de Calcio/administración & dosificación , Citrato de Calcio/uso terapéuticoRESUMEN
Ocular complications are common among end-stage renal disease patients and some complications had been linked to increments of intraocular pressure (IOP) during hemodialysis. The changes of IOP during hemodiafiltration (HDF) have been scarcely investigated and the potential influence of the sodium dialysate concentration is unknown. The aim of this study was to compare the IOP changes during HDF with sodium dialysate concentration, either fixed or individualized. Thirteen end-stage renal disease patients participated in the study; they were treated with HDF using a dialysate sodium profile fixed at 138 mmol and another session with an individualized sodium profile. The intraocular pressure was measured before and after each session and every 30 min during HDF. Both groups had a similar HDF prescription, blood pressure, and biochemical parameters. At the end of hemodiafiltration, sodium concentration decreased only in the fixed sodium profile group. The number of patients with at least an episode of intraocular hypertension during HDF ranged from 5 (19%) to 8 (31%) without significant differences between right and left eye nor between dialysate sodium concentration. During HDF, there is a large variability of IOP; transient events of intraocular hypertension are highly prevalent in this sample, and they are not related to the sodium dialysate concentration.
RESUMEN
The aim of this study was to evaluate the intraocular pressure during hemodialysis and hemodiafiltration. Fifteen patients were enrolled (seven treated with hemodialysis therapy and eight with hemodiafiltration). The intraocular pressure was measured before and after dialysis and every 30 min during dialysis. Before dialysis, both groups had similar dialysis prescription, blood pressure, and biochemical parameters. At the end of dialysis, potassium, and osmolarity decreased in both groups, while systolic blood pressure and sodium decreased in the hemodialysis group, and glucose decreased in the hemodiafiltration group. Mean intraocular pressure was similar between groups at all measured times and had no significant changes during hemodialysis. During minute 120 of hemodiafiltration, mean intraocular pressure in the left eye decreased significantly compared to minute 90. This suggests a high intra-individual variability of intraocular pressure during both types of dialysis, which could be relevant particularly among those with the risk of glaucoma.