P0951THE DIETARY TREATMENT EFFECTIVENESS IN HEMODIALYSIS PATIENTS WITH DIABETES MELLITUS TYPE 2 AND FEATURES OF PROTEIN-ENERGY WASTING
Authors: Mikhailova Nataliia , Tishkina Svetlana , Ermolenko Valentin , Pushkina Anna , Kertsev Andrey 
Published: June 2020

Abstract

Background and Aims
The percentage of patients receiving RRT for ESRD secondary to diabetes mellitus (DM) is equal to 20-30% nowadays and is trending upward. Unfavourable changes in nutrition and body composition is highly prevalent in patients with chronic kidney disease (CKD) undergoing dialysis. DM type 2 (DM2) coupled with CKD is an additional factor for nutrition abnormalities in dialysis patients due to more prominent inflammatory status and insulin resistance. Resting energy expenditure is significantly higher in hemodialysis patients with DM2 than in those without it. Daily energy intake as usual is substantially less than required in the most dialysis patient, suggesting that patients could develop protein-calorie wasting and sarcopenia. The aims of our study were to compare of nutritional status in hemodialysis patients with and without DM2 and to treat revealed nutritional abnormalities by correction of the protein and energy intake.

Method
79 hemodialysis patients (aged 50 to 70 years) were divided in two groups: 40 with DM2 and 39 without DM2. The groups didn’t distinguish by age, gender, comorbidity, dialysis duration and adequacy. In the DM2 group there were no patients with severe diabetes complications or decompensation. All patients kept a 3-days food diary for assessment of protein and other nutrients and energy intake. The examination, which included anthropometry, measurement of body composition by bioimpedance analysis, biochemical parameters (serum albumin, transthyretin, C-reactive protein (CRP), interleukins 1 and 6 (IL1 and IL6), advanced glycation endproducts (AGE)), was performed at baseline, and then after 6 and 12 weeks of the dietary treatment. The pattern of the diet for every patient was based on the individual parameters of nutrient and energy intake obtained from the food diary. The aim of the diet was to make good the deficit of protein and energy intake.

Results
Baseline BMI and degree of abdominal obesity were significantly higher in DM2 group, but lean mass (LM), hand grip strength and gait velocity were significantly less. The significantly more decreased level of transthyretin was identified in DM2 group. Levels of AGE and CRP were not different between the groups, but were twice higher of normal range. IL6 was significantly higher in DM2 group. Protein and energy intake were under dietary recommendations for dialysis patients in DM2 group. We identified positive association between protein intake and levels of albumin and transthyretin and negative with IL1, IL6 and AGE in patients with DM2. In patients without DM2 we revealed negative correlation between LM and CRP. The dynamic of the main anthropometric and biochemical parameters are represented in the table.

Conclusion
A degree of persistent inflammation and sarcopenia more prominent in hemodialysis patients with DM2. Absence of appetite due to inflammation is a probable cause of low protein and energy intake in those patients. Balanced diet based on individual nutritional requirements can effectively improve nutritional status of the dialysis patients with DM2 and decrease inflammation.