DISTURBANCES OF NUTRINIONAL STATUS IN PATIENTS TREATED BY PERITONEAL DIALYSIS: THE ROLE OF CHRONIC INFLAMMATION

this work is devoted to the problem of malnutrition in patients who are treated by peritoneal dialysis, also the role of chronic inflammation was described

DISTURBANCES OF NUTRINIONAL STATUS IN PATIENTS TREATED BY PERITONEAL DIALYSIS

this work is devoted to the problem of malnutrition in patients who are treated by peritoneal dialysis, the main causes of violations of nutritional status were observed, and also the classification of protein-energy malnutrition was described

Factors associated with nutritional status in peritoneal dialysis patients

The aim of our study was to examine the relationship between nutritional status (NS) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and dialysis-related factors.Methods. 105 patients who were treated by CAPD were included in this observational study. To assess the NS we determined the level of serum albumin, body mass index (BMI) and subjective global assessment (SGA). The study was carried out in two stages. At the first stage of the work PD patients’ nutrition status was examined. For further analysis, the patients were divided into four groups according to the condition of the NS: the first group (n = 54) consisted of patients without disturbance of nutrition, the second (n = 27) with mild nutrition disorders, the third (n = 13) - with an average degree and the fourth (n = 11) with a severe degree of malnutrition. At the second stage of the work specialty of the nutritional status and residual renal function, frequency of PD-peritonitis, transport characteristics of the peritoneum were studied.Results. Nutritional disorders were observed in 54 (51.4 %) patients. A mild malnutrition was diagnosed in 28.7 % of patients, medium and severe in 12,38 % and 10,48% of patients, respectively. Parameters of NS, except BMI, were higher in patients without nutrition disorders (ND) comparing with the patients who had it. RRF was higher in patients without ND; but anuria was observed practically in all patients with severe ND. We receive direct relationship between the level of serum albumin and RRF (r = 0.53; p <0,001), and SGA and RRF (r = 0.52; p <0,001). Number of PD – peritonitis was lower in patients with normal NS and the highest in patients with severe ND. Strong correlation between the level of serum albumin, SGA, and the frequency and duration of peritonitis was established (r = - 0.59; p<0,001 and r = - 0.59; p <0,001 respectively). High transport characteristic of peritoneum was associated with lower degree of serum albumin and SGA (p <0,001). There was no relationship established between SGA, serum albumin, BMI, age, duration of CAPD treatment, gender, and main nosology.Conclusions: Thus, ND were diagnosed in more than 50% of the examined patients. ND were associated with reduce of RRF, frequency and duration of PD-peritonitis, high transport characteristics of the peritoneum. There was no correlation between level of serum albumin, SGA and gender, duration of CAPD, main nosology and age. BMI did not have correlation with any parameters. The received data testify the necessity of constant monitoring of laboratory and functional parameters of the nutrition status

NUTRITIONAL DISTURBANCES IN PATIENTS WITH CHRONIC KIDNEY DISEAS STAGE WHO ARE TREATED BY PERITONEAL DIALYSIS AND ITS RELATIONSHIPS WITH HYDRATION STATUS

The aim of the study was to estimate the nutritional status of patients with chronic kidney disease who are treated by CAPD, the prevalence of its disorders according to functional methods. To study the relationship between nutritional status and hydration. Materials and Methods: During the observational one-stage study, 105 patients with CKD 5D stage who were treated by CAPD were included. To assess the NS, serum albumin and body mass index were determined, functional methods were used, namely, SGA and dietary diary analysis. The status of hydration was assessed by clinical examination and bioimpedance analysis. The study was carried out in two stages. At the first, the definition of laboratory and functional indicators of the National Assembly, assessment of the balance of water sectors was carried out. At the second stage, for further analysis, the patients were divided into four groups according to the condition of the NS, determined on the basis of the SGA: the first group (n = 54) consisted of patients without disturbance of nutrition, the second (n = 27) with mild disruption of nutrition, the third (n = 13) — with an average degree, and the fourth (n = 11) - with a severe degree of malnutrition. Results: Weight loss and subcutaneous fat mass for the past 6 months were detected in 43.8% and 37.14% of patients, respectively. Gastrointestinal disorders and loss of muscle mass were detected in 58.1% and 74.3% of patients, respectively. According to the SGA, nutritional disorders were detected in 51 (48.6%) patients. An easy degree of malnutrition was diagnosed in 25.71% of patients, medium and severe — in 12.38% and 10.48% of patients, respectively. For compare of the data obtained from the survey on the composition of water sectors with reference values allows one to assert the presence of hyperhydration in the examined population. A statistically significant difference is achieved by the volume of extracellular fluid, the volume of circulating blood and plasma. These parameters significantly increase depending on the degree of disturbance of the NS (p <0.001). A direct, reliable correlation was obtained between the SGA and serum albumin level (r = 0.74, p <0.0001), BMI (r = 0.55, p <0.0001) and the inverse volume of extracellular fluid (r = -0, 71; p <0.0001). Peripheral edema as a sign of hyperhydration was detected in 31 patients, the significant majority of whom belonged to the third (10 / 37.03% versus 11 / 84.6%, x2 = 7.965, р = 0.005) and the fourth (10/ 37.03 % against 10 /90,9%, yf = 9,098, р = 0,003) to the group. Daily protein intake, also, was significantly lower in patients of the third and fourth groups (p <0.001). Conclusions: Thus, the normal nutritional status was determined in more than 50% of the patients examined. The level of hydration in patients with nutritional disorders is higher than in patients with normal nutritional status. The received data testify to the necessity of constant monitoring of laboratory and functional indices of NS, expediency of routine use of bioimpedance analysis for hydration estimation