Estado nutricional de los enfermos incluidos en un programa de hemodiálisis crónica: Factores de riesgo y evolución clínica

Yuleidi Hernández Reyes, Amaury Lorenzo Clemente, Pedro Ponce Pérez, Rolando Aguiar Moreira, Guillermo Guerra Bustillo

Texto completo:

PDF

Resumen

El estado nutricional de los pacientes con Insuficiencia Renal Crónica Terminal (IRC-T) atendidos en el Programa de Hemodiálisis (HD) del Servicio de Nefrología del Hospital Clínico quirúrgico “Hermanos Ameijeiras” (La Habana, Cuba) se estableció independientemente mediante indicadores antropométricos, bioquímicos y la Encuesta Subjetiva Global (ESG). Se examinaron las asociaciones entre el estado nutricional, por un lado, y las variables demográficas y clínicas del enfermo, las características del esquema de HD, y la autonomía funcional. Asimismo, se evaluó la influencia del estado nutricional sobre la morbilidad y la mortalidad del nefrópata sujeto a tratamiento depurador crónico mediante un estudio analítico, prospectivo y transversal conducido entre Febrero del 2004 – Febrero del 2005. El 50.0% de los pacientes recibió puntajes (B + C) de la ESG. El estado nutricional del enfermo se asoció con valores séricos disminuidos de Albúmina y Creatinina. El estado nutricional del paciente podría componer las influencias de noxas como la presencia de infección, depresión y anorexia. El estado nutricional se asoció con una autonomía funcional disminuida. Una mayor proporción de los desnutridos se concentró entre los pacientes con accesos venosos profundos para la administración de la HD, y tasa de catabolismo proteico < 0.8. La tasa de mortalidad fue del 33.3%. El estado nutricional se constituyó en un predictor por sí mismo de mortalidad antes del año de observación. La mortalidad fue predicha independientemente de la presencia de depresión. Es probable que en un nefrópata concurran trastornos nutricionales, depresión, infección, anorexia, y una autonomía funcional disminuida, junto con valores reducidos de la Creatinina y la Albúmina. Se impone una revisión de la estructura, organización y funcionamiento del Programa hospitalario de Hemodiálisis a fin de enfrentar las consecuencias ominosas de la desnutrición asociada a la IRC-T en HD.

Palabras clave

Desnutrición; Hemodiálisis; Insuficiencia renal crónica; Evaluación nutricional

Referencias

Ikizler TA. Nutrition, inflammation and chronic kidney disease. Curr Opin Nephrol Hyperten 2008;17: 162-7.

Himmelfarb J. Hemodialysis complications. Am J Kidney Dis 2005;45:1122-31.

Rondanelli M, Opizzi A, Bonisio A, Lingua S, Cena H, Giacosa A, Roggi C. Nutritional management of patients suffering of chronic renal failure. Minerva Urol Nefrol 2005;57:33-45.

Akagi S, Sugiyama H, Makino H. Infection and chronic kidney disease. Nippon Rinsho 2008;66: 1794-8.

Cohen SD, Kimmel PL. Nutritional status, psychological issues and survival in hemodialysis patients. Contrib Nephrol 2007;155:1-17.

Cheung AH, Wong LM. Surgical infections in patients with chronic renal failure. Infect Dis Clin North Am 2001;15:775-96.

Teixeira Nunes F, de Campos G, Xavier de Paula SM, Merhi VA, Portero McLellan KC, da Motta DG; et al. Dialysis adequacy and nutritional status of hemodialysis patients. Hemodial Int 2008;12:45-51.

Mercer TH, Koufaki P, Naish PF. Nutritional status, functional capacity and exercise rehabilitation in end-stage renal disease. Clin Nephrol 2004;61(Supl 1):S54-9.

Becker BN, Coomer RW, Fotiadis C, Evanson J, Shyr Y, Hakim RM. Risk factors for hospitalization in well-dialyzed chronic hemodialysis patients. Am J Nephrol 1999;19: 565-70.

Lowrie E, Lew N. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 2000;15:458-482.

Pupim LB, Evanson JA, Hakim RM, Ikizler TA. The extent of uremic malnutrition at the time of initiation of maintenance hemodialysis is associated with subsequent hospitalization. J Ren Nutr 2003;13:259-66.

St Peter WL. Chronic kidney disease and medicare. J Manag Care Pharm 2007;13(9 Suppl D):S13-8.

Aparicio M, Cano N, Chaveau P, Azar R, Canaud B, Flory A; et al. Nutritional status of haemodialysis patients: a French national cooperative study. French Study Group for Nutrition in Dialysis. Nephrol Dial Transplant 1999; 14:1679-86.

Laws RA, Tapsell LC, Kelly J. Nutritional status and its relationship to quality of life in a sample of chronic hemodialysis patients. J Ren Nutr 2000;10:139-47.

Rocco MV, Paranandi L, Burrowes JD, Cockram DB, Dwyer JT, Kusek JW; et al. Nutritional status in the HEMO Study cohort at baseline. Hemodialysis. Am J Kidney Dis 2002;39:245-56.

Kalantar-Zadeh K, Kleiner M, Dunne E, Ahern K, Nelson M, Koslowe R; et al. Total iron-binding capacity-estimated trans-ferrin correlates with the nutritional subjective global assessment in hemodialysis patients. Am J Kidney Dis 1998; 31:263-72.

Barreto Penié J; for the Cuban Group for the Study of Hospital Malnutrition. State of malnutrition in Cuban hospitals. Nutrition 2005;21:487-97.

Barreto Penié J, Santana Porbén S, Martínez González C, Espinosa Borrás A. Desnutrición hospitalaria: la experiencia del Hospital “Hermanos Ameijeiras”. Acta Médica 2003;10:76-95.

Ordóñez Pérez V, Barranco Hernández E, Guerra Bustillo G, Barreto Penié J, Santana Porbén S, Espinosa Borrás A; et al. Estado nutricional de los pacientes con insuficiencia renal crónica atendidos en el programa de Hemodiálisis del Hospital Clínico-Quirúrgico “Hermanos Ameijeiras”. Nutrición Hospitalaria (España) 2007;22:677-94.

Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN. What is Subjective Global Assessment of Nutricional Status? JPEN Journal of Parenteral and Enteral Nutrition 1987;11(1):8-13.

Anónimo. PNO 2.011.98. Encuesta Subjetiva Global del estado nutricional. Manual de Procedimientos. Grupo de Apoyo Nutricional. Hospital Clínico quirúrgico “Hermanos Ameijeiras”. Segunda Edición. La Habana: 2002.

Anónimo. PNO 2.012.98. Evaluación nutricional del paciente hospitalizado. Manual de Procedimientos. Grupo de Apoyo Nutricional. Hospital Clínico quirúrgico “Hermanos Ameijeiras”. Segunda Edición. La Habana: 2002.

Karnofsky DA, Abelmann WH, Craver LF, Burchenal J. The use of nitrogen mustard in the palliative treatment of cancer. Cancer 1948;1:634-56.

Martínez Canalejo H, Santana Porbén S. Manual de Procedimientos bioestadísticas. Editorial Ciencias Médicas. La Habana: 1990.

Fleiss JL. Statistical methods for rates and proportions. New York: John Wiley & Sons; 1981.

Latos DL. Chronic dialysis in patients over age 65. J Am Soc Nephrol 1996;7:637-46.

Naqvi SB, Collins AJ.Infectious complications in chronic kidney disease. Adv Chronic Kidney Dis 2006;13:199-204.

Dhainaut JF, Claessens YE, Janes J, Nelson DR. Underlying disorders and their impact on the host response to infection. Clin Infect Dis 2005;41(Supl 7):S481-9.

Iaina A, Silverberg DS, Wexler D, Iaina Nomy L. The cardio-renal anemia syndrome. Med Pregl 2007;60(Supl 2):145-50.

Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol 2008;52:1527-39.

Zoccali C, Mallamaci F, Tripepi G. Inflammatory proteins as predictors of cardiovascular disease in patients with end-stage renal disease. Nephrol Dial Transplant 2004; 19(Supl 5):V67-V72.

Stenvinkel P. Interactions between inflammation, oxidative stress, and endothelial dysfunction in end-stage renal disease. J Ren Nutr 2003;13:144-8.

Krane V, Drechsler C, Wanner C. Dyslipidemia, inflammation and dialysis outcomes: What we know now. Curr Opin Nephrol Hypertens 2006;15:566-70.

Matuszkiewicz-Rowińska J. The association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Pol Arch Med Wewn 2002;108:901-5.

Efstratiadis G, Tziomalos K, Mikhailidis DP, Athyros VG, Hatzitolios A. Atherogenesis in renal patients: a model of vascular disease? Curr Vasc Pharmacol 2008;6:93-107.

Mucsi I, Kovacs AZ, Molnar MZ, Novak M. Co-morbidity and quality of life in chronic kidney disease patients. J Nephrol 2008;21(Supl 13):S84-S91.

Chilcot J, Wellsted D, Da Silva-Gane M, Farrington K. Depression on dialysis. Nephron Clin Pract. 2008;108:c256-c64.

Tossani E, Cassano P, Fava M. Depression and renal disease. Semin Dial 2005;18:73-81.

Siamopoulos KC, Eleftheriades EG, Pappas M, Sferopoulos G, Tsolas O. Ovine corticotrophin-releasing hormone stimulation test in patients with chronic renal failure: pharmacokinetic properties, and plasma adrenocorticotropic hormone and serum cortisol responses. Horm Res 1988;30:17-21.

Ibrahim S, El Salamony O. Depression, quality of life and malnutrition-inflammation scores in hemodialysis patients. Am J Nephrol 2008;28:784-91.

Dervisoglu E, Kir HM, Kalender B, Eraldemir C, Caglayan C. Depressive symptoms and proinflammatory cytokine levels in chronic renal failure patients. Nephron Clin Pract 2008;108:c272-c7.

Ginieri-Coccossis M, Theofilou P, Synodinou C, Tomaras V, Soldatos C. Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: Investigating differences in early and later years of current treatment. BMC Nephrol 2008;9:14.

Shulman R, Price JD, Spinelli J. Biopsychosocial aspects of long-term survival on end-stage renal failure therapy. Psychol Med 1989;19:945-54.

Piccoli GB, Mezza E, Anania P, Iadarola AM, Vischi M, Torazza MC; et al. Patients on renal replacement therapy for 20 or more years: a clinical profile. Nephrol Dial Transplant 2002;17:1440-9.

Jhamb M, Weisbord SD, Steel JL, Unruh M. Fatigue in patients receiving maintenance dialysis: a review of definitions, measures, and contributing factors. Am J Kidney Dis 2008;52:353-65.

O'Sullivan D, McCarthy G. An exploration of the relationship between fatigue and physical functioning in patients with end stage renal disease receiving haemodialysis. J Clin Nurs 2007; 16(11C):276-84.

Kutner NG, Brogan D, Fielding B. Employment status and ability to work among working-age chronic dialysis patients. Am J Nephrol 1991;11:334-40.

Blake C, Codd MB, Cassidy A, O'Meara YM. Physical function, employment and quality of life in end-stage renal disease. J Nephrol 2000;13:142-9.

Hagren B, Pettersen IM, Severinsson E, Lützén K, Clyne N. The haemodialysis machine as a lifeline: experiences of suffering from end-stage renal disease. J Adv Nurs 2001;34:196-202.

Hagren B, Pettersen IM, Severinsson E, Lützén K, Clyne N. Maintenance haemodialysis: patients' experiences of their life situation. J Clin Nurs 2005;14:294-300.

Hedayati SS, Grambow SC, Szczech LA, Stechuchak KM, Allen AS, Bosworth HB. Physician-diagnosed depression as a correlate of hospitalizations in patients receiving long-term hemodialysis. Am J Kidney Dis 2005;46:642-9.

Hedayati SS, Bosworth HB, Briley LP, Sloane RJ, Pieper CF, Kimmel PL, Szczech LA. Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression. Kidney Int 2008;74: 930-6.

Bednarek Skublewska A, Baranowicz Gaszczyck I, Jóźwiak L, Dzik M, Majdan M, Ksiazek A. Comparison of some nutritional parameters in hemodialysis patients over and below 65 years of age. Pol Arch Med Wewn 2005;113:417-23.

Revkovskaia NS, Denisov AIu, Borisov IA. Nutritional status of old patients on programmed hemo-dialysis. Ter Arkh 2008;80:33-6.

Chung SH, Stenvinkel P, Lindholm B, Avesani CM. Identifying and managing malnutrition stemming from different causes. Perit Dial Int 2007;27(Supl 2):S239-S44.

Raffaitin C, Lasseur C, Chauveau P, Barthe N, Gin H, Combe C, Rigalleau V. Nutritional status in patients with diabetes and chronic kidney disease: a prospective study. Am J Clin Nutr 2007;85:96-101.

Kaufmann P, Smolle KH, Horina JH, Zach R, Krejs GJ. Impact of long-term hemodialysis on nutritional status in patients with end-stage renal failure. Clin Investig 1994 Oct;72(10):754-61.

Chertow GM, Johansen KL, Lew N, Lazarus JM, Lowrie EG. Vintage, nutritional status, and survival in hemodialysis patients. Kidney Int 2000; 57:1176-81.

Schulman G. The dose of dialysis in hemodialysis patients: impact on nutrition. Semin Dial 2004;17:479-88.

Panagoutsos SA, Yannatos EV, Passadakis PS, Thodis ED, Galtsidopoulos OG, Vargemezis VA. Effects of hemodialysis dose on anemia, hypertension, and nutrition. Ren Fail 2002;24:615-21.

Carrero JJ, Chmielewski M, Axelsson J, Snaedal S, Heimbürger O, Bárány P; et al. Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients. Clin Nutr 2008;27:557-64.

Nakao T, Matsumoto H, Okada T, Kanazawa Y, Yoshino M, Nagaoka Y, Takeguchi F. Nutritional management of dialysis patients: balancing among nutrient intake, dialysis dose, and nutritional status. Am J Kidney Dis 2003;41(3 Supl 1):S133-S136.

Azar AT, Wahba K, Mohamed AS, Massoud WA. Association between dialysis dose improvement and nutritional status among hemo-dialysis patients. Am J Nephrol 2007;27:113-9.

Mak RH, Cheung W, Cone RD, Marks DL. Orexigenic and anorexigenic mechanisms in the control of nutrition in chronic kidney disease. Pediatr Nephrol 2005;20:427-31.

Bergström J. Regulation of appetite in chronic renal failure. Miner Electrolyte Metab 1999;25:291-7.

Bossola M, Tazza L, Giungi S, Luciani G. Anorexia in hemo-dialysis patients: and update. Kidney Int 2006;70:417-22.

Burrowes JD, Larive B, Chertow GM, Cockram DB, Dwyer JT, Greene T; et al.; Hemodialysis (HEMO) Study Group. Self-reported appetite, hospitalization and death in hemodialysis patients: findings from the Hemodialysis (HEMO) Study. Nephrol Dial Transplant 2005;20:2765-74.

Morais AA, Silva MA, Faintuch J, Vidigal EJ, Costa RA, Lyrio DC; et al. Correlation of nutritional status and food intake in hemodialysis patients. Clinics 2005;60:185-92.

Zamojska S, Szklarek M, Niewodniczy M, Nowicki M. Correlates of habitual physical activity in chronic haemodialysis patients. Nephrol Dial Transplant 2006;21:1323-7.

Ikizler TA. Effects of hemodialysis on protein metabolism. J Ren Nutr 2005;15:39-43.

Bohé J, Rennie MJ. Muscle protein metabolism during hemodialysis. J Ren Nutr 2006;16:3-16.

Dong J, Li YJ, Lu XH, Gan HP, Zuo L, Wang HY. Correlation of lean body mass with nutritional indicators and mortality in patients on peritoneal dialysis. Kidney Int 2008;73:334-40.

Flanigan MJ, Lim VS, Redlin J. The significance of protein intake and catabolism. Adv Ren Replace Ther 1995;2:330-40.

Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial 2004;17:432-7.

Bossola M, La Torre G, Giungi S, Tazza L, Vulpio C, Luciani G. Serum albumin, body weight and inflammatory parameters in chronic hemodialysis patients: A three-year longitudinal study. Am J Nephrol 2008;28:405-12.

Vernaglione L, Marangi AL, Cristofano C, Giordano R, Chimienti S, Basile C. Predictors of serum creatinine in haemodialysis patients: a cross-sectional analysis. Nephrol Dial Transplant 2003;18:1209–1213.

Mitch WE, Collier VU, Walser M. Creatinine metabolism in chronic renal failure. Clinical Sci 1980;58:327-35.

Chumlea WC. Anthropometric and body composition assessment in dialysis patients. Semin Dial 2004;17:466-70.

Weisbord SD, Fried LF, Arnold RM, Fine MJ, Levenson DJ, Peterson RA, Switzer GE. Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. J Am Soc Nephrol 2005;16:2487-94.

Kakiya R, Shoji T, Tsujimoto Y, Tatsumi N, Hatsuda S, Shinohara K; et al. Body fat mass and lean mass as predictors of survival in hemodialysis patients. Kidney Int 2006;70:549-56.

Enlaces refback

  • No hay ningún enlace refback.




Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.