Abstract | Uvod:
Bolesnici s kroničnom bubrežnom bolesti (KBB) imaju visoku učestalost arterijske hipertenzije (AH) te visok kardiovaskularni rizik koji se povećava s progresijom KBB. Poremećaji nutritivnog statusa česti su u bolesnika s KBB i predstavljaju netradicionalni čimbenik kardiovaskularnog rizika. Cilj navedenoga istraživanja bio je istražiti povezanost čimbenika kardiovaskularnog rizika (AH, prekomjerne tjelesne težine, albuminurije, lipidograma) s nutritivnim statusom (antropometrijskim parametrima i sastavom tijela) bolesnika s KBB i AH. Nadalje, cilj je bio i istražiti učestalost rezistentne arterijske hipertenzije (RAH) te prekomjerne tjelesne težine i pretilosti među ovom populacijom bolesnika, te istražiti postoje li razlike u ispitivanim parametrima kardiovaskularnog rizika i nutritivnog statusa s obzirom na spol, indeks tjelesne mase (ITM) i postojanja RAH. Također, cilj je bio istražiti i povezanost albuminurije s parametrima nutritivnog statusa.
Materijali i metode:
U istraživanje su uključena 32 ispitanika s KBB i AH, medijan dobi 67,5 (IQR=19), 19 (59,38%) muškaraca i 13 (40,62%) žena. Glavne mjere ishoda za svakog ispitanika u istraživanju bile su ITM, omjer struk/visina (WHtR), postotak masnog tkiva izmjeren kaliperom, razina glomerularne filtracija (GF), vrijednosti centralnog sistoličkog (CSKT) i dijastoličkog krvnog tlaka (CDKT), perifernog sistoličkog (PSKT) i dijastoličkog krvnog tlaka (PDKT), srednjeg arterijskog tlaka (MAP) te pulsnog tlaka (PP) za centralni (CMAP, CPP) i periferni krvni tlak (PMAP, PPP), količina mišićnog i masnog tkiva izražena u postotcima i kilogramima, količina visceralnog masnog tkiva i masa bezmasnog tkiva izražene u kilogramima te skeletna mišićna masa izražena u kilogramima i postotcima. Svim ispitanicima određene su i vrijednosti: ureje, kalcija, glukoze, triglicerida, kolesterola – ukupnog, LDL (engl. low-density lipoprotein) kolesterola, albumina, hemoglobina, kreatinina, urata te razina albuminurije. Za mjerenja arterijskog tlaka u ovoj studiji korišten je uređaj „Agedio B900“, koji na neinvazivan način mjeri centralni i periferni arterijski tlak, a za procjenu sastava tijela koristilo se Tanita MC780 Multi Frequency segmentni analizator sastav tijela.
Rezultati:
Rezultati ukazuju kako su muškarci imali statistički značajno više vrijednosti albuminurije (P= 0,016), mase bezmasnog tkiva (P=0,001), mišićne mase (P=0,001), skeletne mišićne mase izražene u kilogramima i postotcima (P=<0,001). Također, muškarci su imali statistički značajno niže vrijednosti triglicerida (P=0.046), manje masnog tkiva izraženog u postotcima (P<0,001) i kilogramima (P=0,001) u odnosu na žene. Statistički značajne razlike u vrijednostima arterijskog tlaka nisu nađene između muškaraca i žena. Rezultati ukazuju kako je normalnu tjelesnu masu (ITM < 25 kg/m2) imalo 37,04% ispitanika. Oni ispitanici koji su imali ITM < 25 kg/m2 imali su statistički značajno manji opseg nadlaktice (P=0,009), opseg struka (P=0,004), WHtR (P=<0,001), količinu masnog tkiva izraženog u postotcima (P<0,001) i kilogramima (P<0,001), manje visceralnog masnog tkiva (P=0,008), PPP (P=0,014) i CPP (P=0,032) u odnosu na one ispitanike sa ITM ≥ 25 kg/m2. Nadalje, ispitanici koji su imali normalnu tjelesnu masu (ITM < 25 kg/m2) imali su statistički značajno veći postotak mišićne mase (P=0,005). Rezultati ukazuju na statistički značajnu povezanost albuminurije sa masom bezmasnog tkiva (P=0.004), mišićnom masom izraženom u kilogramima (P=0.004) te skeletnom mišićnom masom izraženom u postotcima (P=0.014) i kilogramima (P<0.001). Nađena je statistički značajna pozitivna povezanost između CPP s količinom masnog tkiva izraženom u kilogramima (P=0.017) i postotcima (P=0.005) te negativna povezanost s skeletnom mišićnom masom izraženom u postotcima (P=0.008).
Zaključak:
Rezultati ovog istraživanja ukazuju na povezanost između čimbenika kardiovaskularnog rizika i pokazateljima nutritivnog statusa bolesnika s KBB i AH. Također, učestalost RAH, prekomjerne tjelesne težine i pretilosti visoka je u bolesnika s KBB i AH. Nađene su statistički značajne razlike u parametrima kardiovaskularnog rizika i nutritivnog statusa s obzirom na spol i ITM bolesnika s KBB i AH te je nađena i statistički značajna povezanost albuminurije s parametrima nutritivnog statusa. Buduća istraživanja na većem broju ispitanika trebala bi istražiti može li se nutricionističkom intervencijom te promjenama prehrambenih navika, redukcijom tjelesne težine, smanjenjem mase masnog tkiva utjecati na razinu albuminurije, promjene sastava tijela te na kardiovaskularni rizik ove populacije bolesnika. |
Abstract (english) | Introduction:
There is a high frequency of arterial hypertension (AH) among patients suffering of chronic kidney disease (CKD), as well as a high cardiovascular risk that increases along with CKD’s progression. Nutritional status disorders often manifest at CKD patients and represent a non-traditional factor of cardiovascular risk. The goal of this research is to explore the connection between the factors of cardiovascular risks (AH, excessive body weight, albuminuria, lipidogram) and nutritional status (anthropomorphic parameters and body composition) of patients with CKD and AH. Furthermore, the goal is also to investigate the occurrence frequency of resistant arterial hypertension (RAH) as well as overweight and obesity within this patient population and analyse the data for differences in the examined parameters of cardiovascular risk and nutritional status with respect to gender, body mass index (BMI) and the existence of RAH. Likewise, the goal was to research the connection of albuminuria with the parameters of nutritional status.
Materials and methods:
The study involves 32 patients with CKD and AH, age median 67.5 (IQR=19), 19 (59.38%) men and 13 (40.62%) women. The main outcome measures for every patient in the study were BMI, waist to height ratio (WHtR), percentage of body fat measured by a caliper, level of glomerular filtration (GF), worth of central systolic (CSBP) and diastolic blood pressure (CDBP), peripheral systolic (PSBP) and diastolic blood pressure (PDBP), mean arterial pressure (MAP), pulse pressure (PP) for central (CMAP, CPP) and peripheral blood pressure (PMAP, PPP), quantity of muscle and mass tissue expressed in percentage and kilograms, quantity of visceral mass tissue and fat free mass expressed in kg and skeletal muscle mass expressed in kilograms and percentages. All patients were subjected to value determination of following: urea, calcium, glucose, triglycerides, cholesterol – total, low-density lipoprotein (LDL) cholesterol, albumin, haemoglobin, creatinine, urate and albuminuria. “Agedio B900” was used for the measuring of arterial pressure in this study, a device that measures central and peripheral arterial pressure in a non-invasive matter. For assessing body composition Tanita MC780 Multi Frequency segment analyser was used.
Results:
Results display a statistically significantly higher values of albuminuria (P=0.016), fat free mass (P=0.001), muscle mass (P=0.001), skeletal muscle mass expressed in kg and percentage (P<0.001). Also, a statistically significant lower values of triglycerides (P=0.046), fat tissue expressed in percentage (P<0.001) and kilograms (P=0.001) were observed in men compared to women. Statistically significant difference in values of arterial pressure was not found between men and women. Results reveal a normal body mass (BMI < 25 kg/m2) in 37.04% patient. Patients with BMI < 25 kg/m2 had a statistically significantly smaller upper arm circumference (P=0.009), waist circumference (P=0.004), WHtR (P<0.001), quantity of mass tissue expressed in percentage (P<0.001) and kilograms (P<0.001), less visceral mass tissue (P=0.008), PPP (P=0.014) and CPP (P=0.032) in comparison to those patients with BMI ≥ 25 kg/m2. Furthermore, patients with a normal body mass (BMI < 25 kg/m2) had a statistically significantly bigger percentage of muscle mass (P=0.005). Results indicate on a statistically significant connection of albuminuria with mass of fat free mass (P=0.004), muscle mass expressed in kilograms (P=0.004) and skeletal muscle mass expressed in percentage (P=0.014) and kilograms (P<0.001). A statistically significant positive connection between CPP and quantity of fat mass expressed in kilograms (P=0.017) and percentage (P=0.005) was found, as well as a negative connection with skeletal muscle mass expressed in percentage (P=0.008).
Conclusion:
Results of the study show a connection between the factors of cardiovascular risk and indicators of nutritional status of patients with CKD and AH. Furthermore, the frequency of RAH, excessive body weight and overweightness is high in patients with CKD and AH. A statistically significant difference in cardiovascular risk and nutritional status parameters were found with respect to gender and BMI of patients suffering from CKD and AH and a statistically significant connection between albuminuria and parameters of nutritional status was found. Future studies, preferably on a larger number of examinees, should investigate whether a nutritional intervention as well as changes to eating habits, reduction of body weight and reduction of fat tissue mass could affect levels of albuminuria, changes to body composition and cardiovascular risk in this population. |