Background: Malnutrition is an important cause of the excessive morbidity and mortality rate of dialysis patients. Frequent nocturnal home hemodialysis (NHHD) has many benefits compared with conventional thrice-weekly hemodialysis (CHD), due to the virtual absence of dietary restrictions and a much higher overall dialysis efficiency. In this observational study, we investigated whether these benefits of NHHD translate into an improved nutritional intake, with a special emphasis on protein intake. Methods: We prospectively assessed the effect of the transition of CHD to NHHD on nutritional intake (5-day dietary intake journal), normalized protein catabolic rate, and anthropometric parameters in 15 consecutive patients who started NHHD in our center between 2004 and 2009 and completed at least 8 months of follow-up. Data were collected before the transition from CHD to NHHD and 4 and 8 months after the transition. Results: Protein intake, as measured by both dietary intake journal and normalized protein catabolic rate, increased significantly after the transition from CHD to NHHD. Accordingly, phosphate intake increased significantly; however, serum phosphate levels did not increase, despite negligible phosphate binder use during NHHD. Body mass index and upper arm muscle circumference did not change significantly. Conclusion: The transition from CHD to NHHD has a positive effect on nutritional intake, in particular, protein intake. NHHD should be considered in malnourished patients on CHD. © 2012 National Kidney Foundation, Inc.
Background: Malnutrition is an important cause of the excessive morbidity and mortality rate of dialysis patients. Frequent nocturnal home hemodialysis (NHHD) has many benefits compared with conventional thrice-weekly hemodialysis (CHD), due to the virtual absence of dietary restrictions and a much higher overall dialysis efficiency. In this observational study, we investigated whether these benefits of NHHD translate into an improved nutritional intake, with a special emphasis on protein intake. Methods: We prospectively assessed the effect of the transition of CHD to NHHD on nutritional intake (5-day dietary intake journal), normalized protein catabolic rate, and anthropometric parameters in 15 consecutive patients who started NHHD in our center between 2004 and 2009 and completed at least 8 months of follow-up. Data were collected before the transition from CHD to NHHD and 4 and 8 months after the transition. Results: Protein intake, as measured by both dietary intake journal and normalized protein catabolic rate, increased significantly after the transition from CHD to NHHD. Accordingly, phosphate intake increased significantly; however, serum phosphate levels did not increase, despite negligible phosphate binder use during NHHD. Body mass index and upper arm muscle circumference did not change significantly. Conclusion: The transition from CHD to NHHD has a positive effect on nutritional intake, in particular, protein intake. NHHD should be considered in malnourished patients on CHD. © 2012 National Kidney Foundation, Inc.
BACKGROUND & AIMS: Sufficient protein intake is of great importance in hemodialysis (HD) patients, especially for maintaining muscle mass. Daily protein needs are generally estimated using bodyweight (BW), in which individual differences in body composition are not accounted for. As body protein mass is best represented by fat free mass (FFM), there is a rationale to apply FFM instead of BW. The agreement between both estimations is unclear. Therefore, the aim of this study is to compare protein needs based on either FFM or BW in HD patients.METHODS: Protein needs were estimated in 115 HD patients by three different equations; FFM, BW and BW adjusted for low or high BMI. FFM was measured by multi-frequency bioelectrical impedance spectroscopy and considered the reference method. Estimations of FFM x 1.5 g/kg and FFM x 1.9 g/kg were compared with (adjusted)BW x 1.2 and x 1.5, respectively. Differences were assessed with repeated measures ANOVA and Bland-Altman plots.RESULTS: Mean protein needs estimated by (adjusted)BW were higher compared to those based on FFM, across all BMI categories (P < 0.01) and most explicitly in obese patients. In females with BMI >30, protein needs were 69 ± 17.4 g/day higher based on BW and 45 ± 9.3 g/day higher based on BMI adjusted BW, compared to FFM. In males with BMI >30, protein needs were 51 ± 20.4 g/day and 23 ± 20.9 g/day higher compared to FFM, respectively.CONCLUSIONS: Our data show large differences and possible overestimations of protein needs when comparing BW to FFM. We emphasize the importance of more research and discussion on this topic.
Introduction The research group Biobased Resources & Energy (BRE) of Avans focusses on recovery of valuable building blocks from low-value solid and liquid residual streams from agriculture, households and industries. For the valorisation of these residual streams, BRE looks into different biological, chemical and mechanical processes. One of the main issues in the utilisation of residual streams is economic feasibility and the recovery of multiple resources from one residual stream. Using membrane technologies in combination with biological, chemical and/or mechanical processes could offer great opportunities. Central Research Question What is the applicability of membrane technologies for valorisation of different residual streams and is it possible to integrate membrane technology in current and new biorefining projects of research group BRE: Set-up In order to reach the goal of this postdoc, 4 research questions will be answered using literature search, experimentation and modelling: 1) What membrane methods are currently (commercially) available to enhance the results of current projects in research group BRE? 2) What are the essential technical parameters for membrane separation and how can these be optimized? 3) What is the economic impact of using membrane technology in recovery of valuable building blocks from residual streams? 4) What are the effects of using membranes instead of or complementary to currently used methods on the sustainability of valorisation of residual streams? Cooperation The postdoc and the research group BRE want to extend the contact and research cooperation with (regional) businesses and (applied) universities and support and facilitate the introduction and further development of membrane technologies in the curriculum of different Avans study programmes. This will be done via internships, minor projects (together with businesses) and development of study material for courses and trainings.
This research is a collaborative project between Water Future, Looop, and MNEXT to address the valorisation of a residual stream that remain after valorisation of whey towards food and feed applications: whey permeate. This permeate is a high-volume but low-quality stream, which is currently used as a filler for mainly animal feed, but with the large amounts produced in NW-Europe it is essential to valorise whey permeate higher in the value chain, for example into a biobased resource which replace fossil-based resources in the chemical industry. To accomplish this, pre-processing steps are necessary to remove minerals. Electrodialysis (ED) can remove unwanted minerals from whey permeate by applying an electric field across its membranes. Using ED, whey permeate is expected to demineralize into a liquid which is suitable for application as biobased resource for various applications. Moreover, the extracted mineral stream can also be reused. This one-year project aims to quantify and optimize the demineralisation of whey permeates using a lab-scale ED setup to make the whey permeate stream suitable for re-use and thus reduce the environmental impact of this stream. The project involves setting up an ED setup provided by Water Future to treat whey permeates supplied by Looop, assessing the suitability of treated permeate as a biobased resource in the chemical industry and processing the produced mineral streams into new biobased resources. The result of this research will demonstrate the use of ED as a valorisation technique for whey permeates and the integration of multiple processes into a valorisation pathway to transform costly whey permeates into value-added products. MNEXT leads the research development, aiming to potentially establish a recycle strategy for resource recovery in the dairy industry. The results will be presented through educational activities, reports, digital platforms, and conferences to transfer knowledge to a broader audience.
