Composição corporal, depressão, qualidade de vida e mortalidade em hemodiálise

• Autor(a) principal: Barros, Annerose
• Data de Publicação: 2015
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_RS
• Texto Completo: http://tede2.pucrs.br/tede2/handle/tede/6133
• topic: MEDICINA; NEFROPATIAS; DIÁLISE RENAL; COMPOSIÇÃO CORPORAL; DEPRESSÃO; INFLAMAÇÃO; CIENCIAS DA SAUDE::MEDICINA

Chronic kidney disease is a progressive condition, with no healing prospect, yet extended upholding under adequate monitoring and treatment. Approximately 100,000 patients currently undergo dialysis therapy - ninety percent on hemodialysis. Mortality ratio varies between 15 to 20%, being cardiovascular events mainly responsible. Among mental ailments thwarting kidney disease patients, depression is the most frequently associated co-morbidity, and linked to increased mortality and morbidity rates. In patients undergoing hemodialysis, malnourishment may relate with depressive symptoms, besides inflammation and cardiovascular diseases. Life style changes induced by end-stage renal disease impose a number of limitations that end up affecting the quality of life. Protein depletion is commonly observed in patients submitted to hemodialysis, and is associated with higher mortality. Strangely enough, it may be accompanied by weight gain and central fat accumulation. The role of adipocytokines in chronic kidney disease has recently drawn attention: association of serum chemerin to metabolic syndrome indicators, inflammation and obesity has been suggested. The aim of this study was to longitudinally evaluate nutritional status, presence of depressive symptoms, quality of life and mortality of hemodialysis patients, in a cohort study at the São Lucas Hospital /PUCRS, Porto Alegre, Brazil. Stable patients, undergoing hemodialysis for at least three months, were enrolled and evaluated at twelve month-intervals, thereafter. Participants were assessed for: depressive symptoms using the Beck Depression Inventory and for quality of life perception by the WHOQOL-bref questionnaire. Anthropometric data: weight, height, waist circumference; blood collection: for biochemical determinations, high-sensitivity C-reactive protein, chemerin; body composition analysis by direct segmental multi frequency bioimpedance, were obtained at a mid week dialysis session. One hundred and five participants were included. Patients classified as having standard percentage of body fat predominated, although more than half of the enrolled participants presented with excess body fat. There was no significant difference in the rate of depressive symptoms or in the quality of life between groups, classified by nutritional status. The cause more often associated with the outcome death by any cause was cardiovascular event, followed by infection. Lean body mass had a protective effect on survival. Chemerin may have an anti-inflammatory effect, being associated with increased body fat percentage and augmented waist circumference, on end-stage renal disease patients.