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

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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

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