Sobre la influencia del acceso vascular en los indicadores nutricionales e inflamatorios de los nefrópatas en diálisis

Thomas Anthony Norales Figueroa, Dagoberto Semanat Vaillant, Juliette Massip Nicot

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Justificación: Las fístulas arterio-venosas (FAV) y los catéteres venosos centrales (CVC) son los accesos vasculares más empleados en la prestación de hemodiálisis (HD). En los últimos años se ha detectado un aumento en el uso de los CVC, pero un uso mayor de los CVC podría asociarse con peores resultados de la HD. En Cuba no se conoce cómo se relacionan el estado nutricional del nefrópata y el tipo del acceso vascular empleado en la HD. Objetivo: Determinar la repercusión del tipo de acceso vascular empleado en la HD sobre indicadores nutricionales selectos de los pacientes sujetos a HD. Locación del estudio: Servicio de Nefrología, Hospital Clínico-quirúrgico “Hermanos Ameijeiras” (La Habana: Cuba). El estudio se condujo entre Noviembre del 2015 y Mayo del 2016. Serie de estudio: Cincuenta y seis pacientes (Hombres: 50.0 %; Edad promedio: 54.2 ± 31.2 años; Tiempo de permanencia en HD: Hasta 5 años: 84.0 % vs. > 5 años: 16.0 %). La hipertensión arterial (HTA) (32.1 % de la serie de estudio) constituyó la causa más frecuente de daño renal. De acuerdo con el acceso vascular, la serie de estudio se distribuyó como sigue: FAV: 69.6 % vs. CVC: 30.4 %. Diseño del estudio: Transversal, analítico. Métodos: Las variables demográficas, clínicas, antropométricas y hematobioquímicas colectadas en los pacientes HD se distribuyeron según el tipo de acceso venoso. Resultados: Los fenotipos nutricionales fueron: Peso insuficiente para la talla: 16.1 %; Peso adecuado para la talla: 50.0 %; y Exceso de peso: 33.9 %. Los indicadores hematobioquímicos de desnutrición se comportaron como sigue (en orden descendente): Linfopenia: 82.1 %; Hipoprealbuminemia: 64.3 %; Hipotransferrinemia: 57.1 %; Hipoalbuminemia: 51.8 %; Anemia: 39.3 %; Hipocolesterolemia: 32.1 %; respectivamente. La proteína C reactiva (PCR) estaba elevada en el 67.9 % de los nefrópatas crónicos. El tipo de acceso venoso empleado en la prestación de HD no influyó en el comportamiento de los indicadores del estado nutricional. El tipo de acceso venoso tampoco influyó en el valor determinado de la PCR. Conclusiones: El uso de los CVC no se asocial con un mayor deterioro nutricional del paciente en HD.

Palabras clave

Enfermedad renal crónica; Hemodiálisis; Acceso vascular; Catéter; Fístula arteriovenosa; Desnutrición energético-nutrimental; Inflamación

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