Associação entre Marcadores Nutricionais e Desfecho de Mortalidade e de Hospitalização em Idosos em Tratamento Crônico de Hemodiálise

• Autor(a) principal: Rodrigues, Juliana Cordeiro Dias
• Data de Publicação: 2016
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/7216
• topic: Nutritional status; Elderly; Hemodialysis; Mortality; Hospitalization; Mortalidade; Hospitalização; Nutrição; Estado nutricional; Idosos; Hemodiálise; CNPQ::CIENCIAS DA SAUDE::NUTRICAO::ANALISE NUTRICIONAL DE POPULACAO

The prevalence and incidence of elderly patients (> 65 years) on dialysis increased significantly due to the global aging. Therefore, medical doctors, nurses, dietitians and physiotherapist working with hemodialysis (HD) patients, which is the main modality of renal replacement therapy in Brazil, should be prepared to treat comorbidities often observed in elderly patients on HD, such as the occurrence of protein energy wasting (PEW). Bearing that in mind, the aim of the present study is to investigate the nutritional marker related to PEW that better predicts mortality and that evaluates the risk of hospitalization in elderly patients on HD. This is an observational, longitudinal and prospective study with follow up of up to 36 months. Non institutionalized elderly patients (≥ 60 years) on HD for at least 3 months were included in this study. The nutritional status was assessed by objective measurements (anthropometry, bioelectrical impedance, handgrip strength (HGS), serum albumin, geriatric nutritional risk index (GNRI)) and subjective measurements (subjective global assessment of 7 points (SGA) and malnutrition inflammation score (MIS)). The association of these measurements with mortality and hospitalization risk was tested continuously and by the recommended cutoff points for adult patients with chronic kidney disease (CKD). One hundred and seventy three elderly patients (Men: 64.7%) with a mean age of 70.5 ± 7.2 years and HD vintage of 2.89 (1.2; 5.6) years were included in the study. The prevalence of PEW varied from 9.6 to 60%, depending on the nutritional marker tested. During the follow up of 23.6 months (12.0; 34.4; median and interquartile ranges) 61 patients deceased. When comparing the nutritional status between the deceased and those that survived, we observed that hemoglobin, hematocrit, triceps skinfold thickness in women, SGA, the adequacy of HGS and HGS and body cell mass (BCM) in men were significantly lower in the deceased group, while MIS was higher. The survival curves, tested by log-rank test, showed that patients with lower values of BMI, calf circumference, HGS, SGA, GNRI and higher MIS had a lower survival. When the hazard ratio of death was evaluated by Cox regression, with exception of GNRI, the previous markers showed higher mortality risk when compared to the reference group, after adjustment for covariates. In the multivariate model, only SGA remained as predictor of mortality (C-statistic: 0.70). Similar results were observed when the data was evaluated continuously for SGA, MIS, calf circumference and BCM. Regarding the hospitalization events, SGA, MIS, HGS and serum albumin were associated with higher hospitalization risk (assessed by Poisson regression) when these parameters were compatible with PEW. In conclusion, among the methods investigated, SGA and MIS were capable to better predict mortality and risk for hospitalization events, respectively