Prevalencia y detección de la desnutrición en pacientes en diálisis en la unidad de nefrología del Hospital General de Segovia

Abstract

Malnutrition is one the most powerful independent predictors of morbimortality in patients on chronic dialysis. Inflammation, hypercatabolism associated to the dialysis procedure, comorbidities and reductions in protein and calories ingestion are though to be the main causes of malnutrition in those patients. The availability of an ideal (sensible, easy to measure, and reproducible) malnutrition marker, is difficulties by the metabolic changes associated to chronic renal failure. To know the nutritional status of a patient, in order to make individual nutritional recommendations, it is necessary to use a panel of anthropometric, biochemical and dietary measurements; on the other hand, bioelectrical impedance vector analysis has been validated for its use in patients on hemo and peritoneal dialysis and might be helpful for the early detection of nutritional alterations. In this study we evaluated the prevalence of malnutrition in 43 stable dialysis patients, using classical biochemical and anthropometrics parameters, as well as dietary surveys, and bioelectrical impedance vector analysis. According to biochemical parameters, 41,9% to 53% of our patients showed malnutrition, whereas using anthropometrics parameters only 26% were malnourished. Bioelectrical impedance vector analysis demonstrated that 18,6 % of patients showed a reduction on total body fat. Anthropometric and bioimpedance muscle parameters were within normal range in most patients. Patients with an adequate proteincalorie ingestion did not showed better nutritional parameters than the rest, in terms of biochemical and body composition values, so we think that more than a problem of ingestion, malnutrition in these patients is the result of inflammation and hypercatabolism.