| Abstract | Cilj istraživanja:
Poznato je kako je pothranjenost učestala među bolesnicima s različitim stadijima kronične bubrežne bolesti (KBB) te kako je sama hospitalizacija dodatni rizik za razvoj i pogoršanje pothranjenosti. Također, pothranjeni bolesnici imaju veći rizik za razvoj neželjenih komplikacija, zahtijevaju dulju hospitalizaciju i veće troškove liječenja. Stoga je cilj ovog istraživanja bio istražiti prevalenciju nutritivnog rizika među bolesnicima s različitim stadijima KBB te osobitosti nutritivnog statusa bolesnika s različitim stadijima KBB, hospitaliziranim na Zavodu za nefrologiju i dijalizu, Klinike za unutarnje bolesti, Kliničkog bolničkog Centra Split.
Materijali i metode:
Ispitanici u ovom istraživanju bili su bolesnici hospitalizirani na Zavodu za nefrologiju i dijalizu od početka siječnja do kraja ožujka 2016. godine, koji su u potpunosti razumjeli protokol istraživanja te ispitivanju pristupili dragovoljno; koji su stariji od 18 godina; koji dulje od tri mjeseca znaju za dijagnozu KBB; koji se liječe postupkom kronične hemodijalize (HD) ili peritonejske dijalize (PD) ili imaju funkcionalan transplantirani bubreg. Za sve ispitanike zabilježeni su antropometrijski (postotak masnog tkiva, opseg nadlaktice, opseg vrata, opseg struka i bokova te indeks tjelesne mase [ITM]) i biokemijski parametri (npr. kolesterol, albumin) koji predstavljaju pokazatelje nutritivnog statusa. Procjena nutritivnog rizika rađena je za sve ispitanike anketnim upitnikom NRS-2002 (eng. Nutritional Risk Screening), a za bolesnike liječene dijalizom dodatna procjena napravljena je upotrebom MIS (eng. Malnutrition-Inflammation Score).
Rezultati:
U istraživanje je uključeno ukupno 80 ispitanika, od čega 54 (67,5%) muškarca i 26 (32,5%) žena. Prosječna dob ispitanika bila je 65,30±15,78 godina. Nadalje, 71 (88,8%) ispitanik je bio hipertoničan, a 26 (32,5%) ispitanika imalo je potvrđenu dijagnozu šećerne bolesti. Od ukupnog broja ispitanika, 27 (33,8%) ih je imalo kroničnu bubrežnu bolest neovisnu o dijalizi, 37 (46,2%) ispitanika bilo je liječeno dijalizom zbog završnog stadija KBB (HD ili PD), a 16 (20 %) bolesnika imalo je transplantiran bubreg. U inicijalnom probiru nutritivnog statusa korištenjem NRS-2002 upitnika, 35 (43,8%) bolesnika nije zahtijevalo daljnji finalni probir nutritivnog statusa, dok je 45 (56,2 %) bolesnika imalo bar jedan potvrdan odgovor pa su zahtijevali daljnji probir nutritivnog statusa. U svih ispitanika nađena je i statistički značajna negativna korelacija između serumskog kreatinina i parametara anemije: eritrocita (r=-0,567, p<0,001), hemoglobina (r=-0,464, p<0,001) i hematokrita (r=-0,443, p<0.001). Također, rezultati ovog istraživanja upućuju na statistički značajnu povezanost između albumina i serumskih vrijednosti željeza. Nadalje, rezultati pokazuju da žene imaju statistički značajno veći ITM, veći postotak masnog tkiva te veći opseg bokova, u usporedbi s muškarcima (27,20 ± 5,40 vs. 25,25 ± 3,03, p=0,025), (0,28. ± 0,08 vs. 0,22 ± 0,07, p=0,001), (101,09 ± 8.48 vs. 96,97 ± 6.22, p=0,020). S druge strane, muškarci su imali statistički značajno više vrijednosti eritrocita, hemoglobina i hematokrita (3,81 ± 0,80 vs. 3,48 ± 0,69, p=0,042), (111,72 ± 22,13 vs. 100,74 ± 17,57, p=0,020), (0,34 ± 0,06 vs. 0,31 ± 0,05, p=0,031). Rezultati su pokazali i statistički značajnu negativnu korelaciju između MIS i serumske razine ukupnih proteina (r=-0,501, p=0,004), albumina (r=-0,567, p<0,001), TIBC (r=-0,631, p=0,002). Također, nađena je statistički značajna povezanost između NRS zbroja i MIS u bolesnika liječenih dijalizom (r=0,472, p=0,005).
Zaključak:
Rezultati istraživanja pokazuju kako je među hospitaliziranim bolesnicima s različitim stadijima KBB veliki postotak bolesnika koji su pod nutritivnim rizikom. Također, nađena je i jasna povezanost parametara nutritivnog statusa s pokazateljima anemije, kao i jasne spolne razlike. Buduća, prospektivna, multicentrična istraživanja trebala bi dati odgovor na pitanje može li se intenzivnim praćenjem nutritivnog statusa i intervencijama tijekom hospitalizacije bolesnika s različitim stadijima KBB utjecati na razvoj neželjenih komplikacija tijekom i nakon hospitalizacije te poboljšati liječenje anemije, koja je česta komplikacija u sklopu zatajenja bubrežne funkcije. |
| Abstract (english) | Objectives:
It is well known that malnutrition is common among patients in different stages of chronic kidney disease (CKD) and that hospitalization further increases the risk of development and exacerbation of malnutrition. In addition, malnourished patients are at a higher risk of developing complications, require longer hospital stays and incur increased costs of care. The purpose of this paper was to study the prevalence of nutritional risk among patients in various stages of CKD who are hospitalized at the Department of Nephrology and Dialysis at the University Clinical Hospital Split, as well as the characteristics of their nutritional status.
Materials and methods:
The participants in this study were all patients hospitalized at the Department of Nephrology and Dialysis, from the beginning of January 2016 until the end of March 2016, who willingly agreed to participate; who were older than 18 years of age; who had been aware of their diagnosis for more than three months prior to the start of the study; who are undergoing renal replacement therapy in the form of hemodialysis (HD) or peritoneal dialysis (PD) or have a transplanted kidney. We obtained anthropometric measurements (body fat percentage, mid-upper arm circumference, neck circumference, waist and hip circumferences, body mass index [BMI]) and biochemical values used for assessing nutritional status (such as cholesterol and albumin) from all participants. Nutritional risk assessment was done using the nutritional risk screening (NRS-2002) questionnaire, while an additional assessment was undertaken for all patients on dialysis using the malnutrition-inflammation score (MIS).
Results:
The study was carried out on 80 subjects, of which 54 (67.5%) males and 26 (32.5%) females. The average age was 65.30±15.78 years. Moreover, 71 (88.8%) subjects were hypertensive and 26 (32.5%) had a confirmed diagnosis of diabetes. Of the total number of participants 27 (33.8%) had CKD that did not require dialysis, 37 (46.2%) required dialysis due to end-stage renal disease (HD or PD) and 16 (20%) had received a kidney transplant. According to the NRS-2002 questionnaire, 35 (43.8%) patients did not require any further nutritional screening, whereas 45 (56.2%) gave at least one positive answer and thus required further screening. Statistically significant negative correlations between serum creatinine level and anemia indices such as erythrocytes (r=-0.567, p<0.001), hemoglobin (r=-0.464, p<0.001) and hematocrit (r=-0.443, p<0.001) were found among all study participants. In addition, a statistically significant correlation was found among all study participants between serum albumin and iron (r=0.297, p=0.020). Furthermore, female patients had a significantly higher BMI (27.20 ± 5.40 vs. 25..25 ± 3.03, p=0.025), body fat percentage (0.28 ± 0.08 vs. 0.22 ± 0.07, p=0.001) and hip circumference (101.09 ± 8.48 vs. 96.97 ± 6.22, p=0.020), whereas male patients had a significantly higher erythrocyte count (3.81 ± 0.80 vs. 3.48 ± 0.69, p=0.042), hemoglobin level (111.72 ± 22.13 vs. 100.74 ± 17.57, p=0.020) and hematocrit level (0.34 ± 0.06 vs. 0.31 ± 0.05, p=0.031). The results of this study also showed a statistically significant negative correlation between MIS and total serum protein (r=-0.501, p=0.004), albumin (r=-0.567, p<0.001), TIBC (r=-0.631, p=0.002). Finally, a statistically significant positive correlation was found between NRS-2002 score and MIS among dialysis patients (r=0.472, p=0.005).
Conclusion:
The results of this study demonstrate a high prevalence of nutritional risk among hospitalized patients in different stages of CKD. A clear association was found between parameters of nutritional status and markers for anemia. We also found significant gender differences in nutritional status. Future, prospective, multicentric studies should provide answers with regards to the feasibility of delaying or preventing the development of complications during and after hospitalization, as well as improving the efficacy of treating anemia, through careful monitoring of CKD patients' nutritional status and frequent therapeutical interventions during their hospital stay. |
