In a cross-sectional study of more than 30% of French dialysis patients (N = 7,123), we evaluated the relationships between predialysis plasma bicarbonate concentration and nutritional markers. Data including age, gender, cause of end-stage renal disease (ESRD), time on dialysis, body mass index (BMI), blood levels of midweek predialysis albumin, prealbumin, and bicarbonate were collected. Normalized protein catabolic rate (nPCR), dialysis adequacy parameters, and estimation of lean body mass (LBM) were computed from pre- and postbicarbonate-dialysis urea and creatinine levels according to the classical formulas of Garred. Average values (+/- 1 SD) were age 61 +/- 16 years, BMI 23.3 +/- 4.6 kg/m2, dialysis time 12.4 +/- 2.7 h/week, HCO3 22.8 +/- 3.5 mmol/L, albumin 38.7 +/- 5.3 g/L, prealbumin 340 +/- 90 mg/L, Kt/V 1.36 +/- 0.36, nPCR 1.13 +/- 0.32 g/kg BW/day, and LBM 0.86 +/- 0.21% of ideal LBM. A highly significant negative correlation was observed between predialysis bicarbonate levels (within a range of 16-30 mmol/L, 95% of this population) and nPCR confirmed by analysis of variance using bicarbonate classes (p < 0.0001). Bicarbonate was also negatively correlated with albumin, prealbumin, BMI, and LBM. No relationship was noted between bicarbonate and Kt/V despite a positive correlation between Kt/V and nPCR. It is likely that a persistent acidosis observed despite standard bicarbonate dialysis was caused by a high dietary protein intake which results in an increased acid load, but also overcomes the usual catabolic effects of acidosis.

Acidosis↗

PubMedDate not supplied

[Monocytic leukemia, Shilling type, with cutaneous lesions].

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Aged↗

PubMedDate not supplied

[Myasthenia gravis. Otorhinolaryngological considerations].

Myasthenia gravis is a motor neuron disease caused by the presence of antibodies against acetylcholine receptors that interfere with proper functioning of the neuromuscular junction. Twenty percent of patients show bulbar involvement as the first indication of disease, with symptoms such as rhinolalia, dysphagia or phonasthenia. We report the cases of five patients for which our intervention was requested. We were involved in capacities ranging from the interpretation of the first symptom of disease to assessment of surgical possibilities for the treatment of chronic aspiration and severe respiratory symptoms in patients with major dysphagia. We review the scant bibliography published in the last five years.

Adolescent↗

PubMedDate not supplied

Low protein diets and outcome of renal patients.

Protein-restricted diets have been proposed in patients with chronic renal failure (CRF) to correct uremic symptoms and to slow the progression of CRF thus delaying the initiation of dialysis. Questions have been raised about the compliance to such diets, their nutritional safety and efficacy. In two-thirds of selected and motivated patients, satisfactory compliance is observed; however, in the overall predialysis population, compliance is fair and does not exceed 50%. When patients are carefully monitored, protein-restricted diets, rather than inducing malnutrition, may prevent it. Moreover, the outcome of these patients, when treated by dialysis, is not affected by prior dietary prescription. A small but real beneficial effect of low protein diet (LPD) on the rate of progression of CRF is observed in nondiabetic renal diseases, but their beneficial effect seems to be greater in diabetic renal disease. Meta-analyses confirm that LPD can effectively postpone renal replacement therapy by moderately slowing the decline in GFR and also by substantially delaying the onset of uremic symptoms.

Diet, Protein-Restricted↗