Running head: ABSTRACT AND SUMMARY

Research Article and Evidence Summary

Alyssa Collins
University of Southern Mississippi

Running head: ABSTRACT AND SUMMARY

Section 1. Evidence Worksheet for Primary Research Report
Citation:

Raffaitin, C., Lasseur, C., Chauveau, P., Barthe, N., Gin, H.,
Combe, C., & Rigalleau, V. (2007). Nutritional
status in patients with diabetes and chronic kidney
disease: A prospective study. The American Journal
of Clinical Nutrition, 85, 96-101. Retrieved from
http://ajcn.nutrition.org/content/85/1/96.full.pdf html

Study Design:
Research Purpose:
Inclusion Criteria:

Exclusion Criteria:
Description of Study
Protocol
Data Collection
Summary:

The research was a prospective study.

The purpose of the study was to examine the implications of
nutrition status on patient outcomes with both diabetes
mellitus and chronic kidney disease (CKD).
Participants were included in the study if they were
diagnosed with either type 1 or type 2 diabetes, and had a
glomerular filtration rate of less than or equal to 60
mL/min/1.73m2.
Subjects were excluded if they were less than 18 years of
age or were pregnant at the time of enrollment.
The study was based on follow-ups with nephrologists and
dietitians who created a joint medical file for each patient.
The follow-up on patients had both a diabetic and renal
component.
To follow up on the diabetes element, there was a required
one visit every four months and one short stay at the
hospital every two years. At these visits, glycosylated
hemoglobin was measured. A normal range was considered
less than eight percent for type II diabetics, and less than 7
percent for type I diabetics. To follow up on the nephrologic
aspect, visits were every two, four or 12 months depending
on the patients GFR. Dietary recommendations on both
renal and diabetic diets were addressed if patients labs fell
outside of the ranges. At baseline and after two years,
measurements were taken of blood pressure, biochemical
data, GFR, body composition and resting energy
expenditure (REE) by indirect calorimetry. After two years,
patients not on hemodialysis were admitted to the hospital
to determine GFR, metabolic control and nutritional status.
Any patients who were on hemodialysis had this visit
around six months after the start of dialysis.

Running head: ABSTRACT AND SUMMARY

Description of Actual
Data Sample:
Summary of Results

Author Conclusion:

Review Comments:

At baseline, there were no statistical differences in age, sex,

GFR, weight, lean body mass (LBM) or REE. A total of 45
participants were enrolled in and completed the study.
Of the 45 study participants, 35 did not require hemodialysis
after two years. Glycosylated hemoglobin, LDL cholesterol,
improved during the follow-up. Additionally, they had an
increase in LBM, weight and body mass index (BMI). GFR
in these patients did decline, and was negatively correlated
with initial BMI (p=0.031) and GFR (p=0.046). The ten
patients who started on dialysis had a significant loss of
LBM (p=0.046) and GFR.
For patients with CKD and diabetes, nutrition status is
improved when diabetes is well controlled, and is worsened
by dialysis. GFR is declined more slowly in patients with a
higher initial BMI.
Strengths of the study include a 100 percent retention rate
and the length of study. Two years with the same population
allows for more accurate data. A limitation of the study is
sample size; a larger population would have allowed for
more data collection.

Section 2. Use of Evidence in Patient Care

Diabetes is a chief risk factor for CKD. Uncontrolled diabetes leads to damage of
blood vessels in the kidney which causes the blood to not be properly filtered. As more
damage occurs, the more kidney function is impaired. Additionally, insulin is
metabolized and excreted by the kidneys. When kidney function is compromised, more
insulin stays in the body, which can lead to severe hypoglycemia. As these two diseases
are so interconnected, many patients experience both conditions together. According to
the research presented in The American Journal of Clinical Nutrition, nutrition status is
important in preventing the progression of these diseases. In order to combat the decline
in GFR as well as the poor nutrition status associated with severe CKD, it is important to
control diabetes through diet. Moreover, a higher initial BMI is actually helpful in
maintaining nutrition status and keeping the patient off dialysis. As a dietitian, I would

Running head: ABSTRACT AND SUMMARY

explain to the patient how these two conditions are closely related. I would also explain
how diet is vital in maintaining a good nutrition status and general health. The patient has
a high BMI, which I would explain is beneficial in this situation. He is already on
hemodialysis, which means nutrition is even more important for his situation. I would
explain how dialysis causes weight loss and malnutrition, so he needs to be vigilant in
controlling his diabetes to decrease the side effects of dialysis. According to the Evidence
Analysis Library, MNT by a registered dietitian improves both anthropometric and
biochemical data for patients with CKD. Since the patient was recently placed on
hemodialysis, it is extremely important as a dietitian to continue to educate the patient on
both diets in order to better his health status during dialysis treatment.
Section 3. References
Academy of Nutrition and Dietetics Evidence Analysis Library (2010). CKD: MNT.
Academy of Nutrition and Dietetics,
https://www.andeal.org/topic.cfm?menu=1400&cat=4487
Raffaitin, C., Lasseur, C., Chauveau, P., Barthe, N., Gin, H., Combe, C., & Rigalleau, V.
(2007). Nutritional status in patients with diabetes and chronic kidney disease: A
prospective study. The American Journal of Clinical Nutrition, 85, 96-101.
Retrieved from http://ajcn.nutrition.org/content/85/1/96.full.pdf html