Frequency and characteristics of metabolic disorders in patients on haemodialysis

Abstract

Background/Aim. Metabolic syndrome and malnutrition represent metabolic abnormalities which significantly characterize patients on haemodialysis. The aim of the study was to determine the incidence and find characteristics of metabolic disbalance in patients on haemodialysis. Methods. The study involved 124 patients on chronic haemodialysis at the Clinical Centre Kragujevac. There were analyzed demographic and anthropometric characteristics of the examined patients. Of clinical characteristics, there were determined smoking habit, time on dialysis, arterial pressure; of comorbide states there were recorded heart diseases and diabetes mellitus. Routine biochemical analyses were carried out by a standard laboratory procedure. Results. Metabolic syndrome was found in 29.8% of the examined patients. The patients with metabolic syndrome were older as compared to the patients without metabolic syndrome (58.45?12.91 vs 52.25?11.63 years). The values of systolic pressure (143.88?19.75 vs 133.01?22.93 mmHg; p = 0.014), body mass index (21.2?3.71 vs 19.4?2.88 kg/m2; p = 0.001), fat body mass (19.57?8.47 vs 16.45?5.82%; p = 0.0002) and waist scope (89?12.54 vs 96?12.34 cm; p = 0.0001) were significantly higher in the patients with metabolic syndrome as compared to those without metabolic syndrome. The values of erythrocytes (3.4?0.45 vs 19?0.53 ? 1012; p = 0.04) and hemoglobin (107?15.76 vs 101?13.87 g/l; p = 0.009), glycaemia (9.5?8.15 vs 5.6?1.4 mmol/l; p = 0.04) triglycerides (2.44?1.8 vs 1.41?0.64 mmol/l; p = 0.007), HDL cholesterol (1.11?0.19 vs 0.82?0.25 mmol/l; p = 0.005) and albumins (32.5?5.6 vs 29.5?3.7 g/l; p = 0.007) were statistically higher in the patients with metabolic syndrome than in patients without disturbance. Diabetes mellitus was a significant etiological factor of renal insufficiency in the patients with metabolic syndrome (p = 0.008). Conclusion. In our study approximately 30% of patients on haemodialysis had pronounced metabolic syndrome. The older, more obese men with increased levels of triglycireds and glucose in the serum dominated among them. Diabetes mellitus was a leading etiological factor of renal insufficiency in these patients.Uvod/Cilj. Metabolicki sindrom i malnutricija jesu metabolicke abnormalnosti koje znacajno karakterisu bolesnike na hemodijalizi. Cilj rada bio je da se utvrdi incidencija i odrede karakteristike metabolickih disbalansa bolesnika na hemodijalizi. Metode. Studija je obuhvatila 124 bolesnika koji se lece hronicnim hemodijalizama u Klinickom centru Kragujevac. Analizirane su demografske i antropometrijske karakteristike ispitanika. Od klinickih karakteristika odredjivana je navika pusenja cigareta, duzina dijaliziranja, arterijski pritisak i prisustvo kardioloskih oboljenja i dijabetes melitusa. Rutinske biohemijske analize radjene su standardnom laboratorijskom procedurom. Rezultati. Metabolicki sindrom utvrdjen je kod 29,8% ispitanika. Bolesnici sa metabolickim sindromom bili su stariji u odnosu na bolesnike bez metabolickog sindoma (58,45?12,91 vs 52,25?11,63 godina). Vrednosti sistolnog pritiska (143,88?19,75 vs 133,01?22,93 mmHg; p = 0,014), indeksa telesne mase (21,2?3,71 vs 19,4?2,88 kg/m2; p = 0,001), masna masa tela (19,57?8,47 vs 16,45?5,82%; p = 0,0002) i obima struka (89?12,59 vs 96?12,34 cm; p = 0,0001) znacajno su vise kod bolesnika sa metabolickim sindromom u odnosu na bolesnike bez metabolickog sindroma. Eritrociti (3,4?0,45 vs 19?0,53 1012/l; p = 0,04), hemoglobin (107?15,76 vs 101?13,87 g/l; p = 0,009), glikemija (9,5?8,15 vs 5,6?1,4 mmol/l; p = 0,04), trigliceridi (2,44?1,8 vs 1,41?0,64 mmol/l; p = 0,007), HDL holesterol (1,11?0,19 vs 0,82?0,25 mmol/l; p = 0,005) i albumini (32,5?5,6 vs 29,5?3,7 g/l; p = 0,007) imali su statisticki znacajno vece vrednosti kod ispitanika sa metabolickim sindromom u odnosu na bolesnike bez ovog poremecaja. U grupi ispitanika sa metabolickim sindromom 21,6% imalo je dijabetes melitus kao etioloski faktor bubrezne insuficijencije, a kod bolesnika bez elemenata za ovu metabolicku abnormalnost, njih 5,7%; ta razlika bila je statisticki znacajna (p = 0,008). Zakljucak. U nasem istrazivanju jedna trecina hemodijaliznih bolesnika ima izrazen metabolicki sindrom, medju kojima dominiraju stariji, gojazni muskarci koji imaju vecu koncentraciju triglicerida i vise vrednosti glikemije. Kod ovih bolesnika dijabetska nefropatije je najznacajnija etioloska kategorija terminalne bubrezne insuficijencije.