Caracterização e estado nutricional de portadores de insuficiência renal crônica em tratamento hemodialítico no Distrito Federal

Abstract

The major purpose of the present master thesis was to describe the nutritional profile of patients with Chronic Kidney Disease (CKD) undergoing hemodialysis (HD). CKD is characterized by failure of renal function, associated with changes in electrolyte balance and acid-base, hormonal and nutritional disorders. Hemodialysis (HD) is the most widely used dialysis today. Nutritional assessment of CRF patients on hemodialysis helps to identify risk factors for malnutrition. METHODS: Demographic, social, economic and epidemiological data were acquired to describe the profile of the population in HD and analyze their nutritional status. The research population was composed by adults ≥ 18 years, with more than 3 months of hemodialysis. Questionnaires were used as socioeconomic data collection instrument. Serum albumin values and Kt/V were obtained from patient charts with the earliest date of anthropometric measurements. After hemodialysis session, anthropometric measurements were obtained: weight and height; arm (AC) and waist circumferences (WC) and triceps skinfold (TSF). The following parameters proposed by the International Society of Renal Nutrition and Metabolism were used for determination of patients with protein-energy malnutrition: serum albumin <3.8 g / dL and / or BMI <23 kg / m2 and / or arm muscle circumference (AMC) with reduction of> 10% relative to the 50th percentile of the NHANES II. Patients who had normal values for the three parameters simultaneously were classified as adequate nutritional status. For statistical analysis, the Kolmogorov-Smirnov and Shapiro-Wilk were applied to assess whether the data had normal distribution. We used the t-test of Student or Mann-Whitney test for parametric and non-parametric data, respectively, and to compare gender related data. For categorical variables we used the chi-square test and Fisher's exact test. The Pearson correlation test was used to assess the relationship between variables. A p value <0.05 was considered statistically significant. RESULTS: From a total of 96 patients in five different HD centers in the Federal District, there were 57% male, 43% female and the mean age was 54 ± 15 years. It was observed that 54% of patients were brown, 21% white, and 18% black. 52% were born in the Northeast region, in the Midwest (30%) and Southeast (14%) regions respectively. The causes of chronic renal failure were attributed to systemic hypertension (44%), followed by diabetes mellitus (27%), glomerulonephritis (9%) or other disorders (19%), highlighting lupus erythematosus (SLE) and bladder neurogenic as other causes. Only 14% of those patients had comorbidities (hypertension 11 and diabetes together). The value of serum albumin of the patients was 3.8 ± 0.4 mg / dL, being higher in men when compared to women (3,9 ± 0,4 vs 3,7± 0,4 mg / dL respectively; P= 0.006). For the evaluation of protein-calorie malnutrition the International Society of Renal Nutrition and Metabolism parameters were used. Regarding BMI of 96 evaluable patients, 41 patients (43%; 18 women) had a BMI less than 23 kg / m2. 48 patients (50%; 12 women; P <0.05 vs men) had a reduction in their AMC, more than 10% compared to the 50th percentile. 32 patients (33%; 18 women) had albumin value lower than 3.8 mg / dL. When all three parameters were considered together, 14 patients were identified with (15%; 57 ± 14; 7 females) protein-energy malnutrition characteristics. We found a positive relationship between albumin and AC, AMC, MAA and MAA boneless. CONCLUSION: The thesis concluded upon a positive and significant correlation between albumin and AC, AMC, MAA and MAA boneless that reinforces the importance of the nutritional profile of nephropathic patients for preventing malnutrition. Hypertension and diabetes are present in 1/4 of the population studied.