Influência do estado nutricional e inflamatório na mortalidade de pacientes submetidos à hemodiálise

Abstract

Introduction: Chronic kidney disease is a global public health problem and patients undergoing hemodialysis (HD) present energy-protein malnutrition (DEP) frequently and presenting a multifactorial etiology, resulting in tissue losses with functional consequences, associated with high morbidity and unfavorable prognosis. The low albumin value is associated with the state of persistent inflammation, being the main responsible for the documented association between mortality and hypoalbuminemia. The present study aimed to analyze the influence of nutritional and inflammatory status on the mortality of patients submitted to HD. Methods: Observational longitudinal study, carried out in the HD program of the Institute of Integral Medicine Professor Fernando Figueira - IMIP (Recife-PE), from August 2015 to November 2016. Clinical data (dialysis time, underlying disease and clinical outcome), biochemical tests (C-reactive protein and serum albumin) and anthropometric indicators, such as body mass index, waist circumference, waist-to-height ratio (WHT), arm muscle circumference and triceps skinfold (TCd), were analyzed. Results: Fifty-five patients with a mean age of 47.84 ±16.5 years were evaluated. It was evidenced that 16.4% of the patients died and that the male sex presented a higher risk of mortality when compared to the female (HR 12.7, p=0.030). Regarding biochemical evaluation, a significant decrease in mortality was observed with increased serum albumin levels (HR 0.05, p=0.031). Regarding anthropometric evaluation, it can be observed that adequate WHT was associated with decreased mortality (HR 0.11, p=0.027). Conclusion: It can be concluded that it is extremely important to identify early changes in albumin and WHT levels, as it will enable targeted dietotherapeutic treatment with the aim of reducing the risk of mortality in this population.