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

  • I. Dudar SI «Institute of Nephrology NAMS of Ukraine
  • A. Shymova SI «Institute of Nephrology NAMS of Ukraine
  • I. Shifris SI «Institute of Nephrology NAMS of Ukraine
  • E. Krasiuk Kyiv City Scientific and Practical Center of nephrology and dialisis
  • Ch. Abrahamovich Danylo Halytsky Lviv National Medical University
Keywords: chronic kidney disease, renal replacement therapy, peritoneal dialysis, nutritional status, subjective global assesment, dietary diares, hydration.

Abstract

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.

Downloads

Download data is not yet available.

References

Національний реєстр хворих на хронічну хворобу нирок та пацієнтів з гострим пошкодженням нирок: 2015 рік; Державна установа «Інститут нефрології НАМН України»; гол. ред. Колесник М.О. – К., 2016. – 200 с.

Строков А.Г. Показатель относительного объема крови у пациентов на программном гемодиализе / Строков А.Г., Терехов В.А. // Нефрология и диализ. 2010 – Т. 12. С. 101–105.

Adequacy of dialysis and nutrition in continuous peritoneal dialysis: Association with clinical outcomes: Canada-USA (CANUSA) Peritoneal Dialysis Study Group / J. Am. Soc. Nephrol. – 1996. – Vol. 7. – Р. 198–207.

Blumenkrantz M. J. Methods for assessing nutritional status of patients with renal failure / Blumenkrantz M.J., Kopple J.D., Gutman R.A. // Am. J. Clin. Nutr. – 2012. – Vol. 33. – P. 1567–1585.

Devolder I. P. Body composition, hydration, and related parameters in hemodialysis versus peritoneal dialysis patients / Devolder I., Verleysen A., Vijt D., Vanholder R., Van Biesen W. // Am. Soc. Nephrol. – 2012. – Vol. 8. – Р. 219–220.

Garosi G. Encapsulating peritoneal sclerosis / Garosi G., Mancianti N., Corciulo R., La Milia V., Virga G. // J. Nephrol. – 2013. – V. 26 (21). – P. 177–187.

Giria K. Correlation between subjective global assessment and serum albumin in hemodialysis patients / Girija K., Radha R. // International Journal of Recent Scientific Research Research – 2015.– Vol. 6. – P. 147–154.

Li–Tao W. Strong Association Between Volume Status and Nutritional Status in Peritoneal Dialysis Patients / Li–Tao W., Cheng T. // Am J Kidney Dis – 2015.– Vol. 4. – P. 891–902.

National Kidney Foundation – K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure //Am. J. Kidney Dis. – 2000. – Vol. 35. – Р. 1–140.

Slomowitz L. Effect of energy intake on nutritional status in maintenance dialysis patients / L. A. Slomowitz, F. J. Monteon, M. Grosvenor // Kidney Int. – 2009. – Vol. 35. – P. 704–711.

Enia G. Subjective global assessment nutrition in dialysis patients / Enia G., Sicuso C., Alati G., Zoccali C. // J. Am. Soc. Nephrol. – 1991. – Vol. 1. – P. 323.

Wang A. Important factors other than dialysis adequacy associated with inadequate dietary protein and energy intakes in patients receiving maintenance peritoneal dialysis / Wang A., Sea M., Wang M., Lam C. // Am J Clin. Nutr. – 2003. – Vol. 77. – P. 834–841

Published
2018-03-09
How to Cite
Dudar, I., Shymova, A., Shifris, I., Krasiuk, E., & Abrahamovich, C. (2018). NUTRITIONAL DISTURBANCES IN PATIENTS WITH CHRONIC KIDNEY DISEAS STAGE WHO ARE TREATED BY PERITONEAL DIALYSIS AND ITS RELATIONSHIPS WITH HYDRATION STATUS. Ukrainian Journal of Nephrology and Dialysis, (1(57), 24-32. https://doi.org/10.31450/ukrjnd.1(57).2018.01