ABSTRACT
Vascular calcifications affect 80% to 90% of chronic kidney disease patients and are a predictive factor of cardiovascular mortality. Sarcopenia and protein-energy wasting syndrome are also associated with mortality. The aim was to assess the relationship between vascular calcification, sarcopenia, and protein-energy wasting syndrome (PEW) in automated peritoneal dialysis patients. Fifty-one maintenance automated peritoneal dialysis patients were included (27 were male, mean age 39 ± 14 years). Vascular calcification was assessed based on abdomen, pelvis, and hand radiographs. Sarcopenia was assessed with bioimpedance analysis and a hand grip strength test. The Malnutrition-Inflammation Score and the presence of PEW were also assessed. Vascular calcification was present in 21 patients (41.2%). Univariate logistic regression analysis showed that age (p = 0.001), Malnutrition-Inflammation Score (p = 0.022), PEW (p = 0.049), sarcopenia (p = 0.048), and diabetes (p = 0.010) were associated with vascular calcification. Multivariate logistic regression analysis showed that age (p = 0.006) was the only variable associated independently with vascular calcification. In conclusion, there is association between vascular calcification, PEW, and sarcopenia in patients with maintenance automated peritoneal dialysis. These associations are not independent of age. This demonstrates the importance of nutritional status in the prevention of vascular calcification.
ABSTRACT
The number of patients with advanced / end-stage chronic kidney disease (ESRD) with some modality of renal replacement therapy (RRT) has been on the rise significantly. Peritoneal dialysis (PD) represents 11% of the world dialysis population. Different options for RRT have been associated with a greater risk of developing complications, such infections, metabolic alterations and nutritional complications, specifically a higher incidence of protein-energy wasting (PEW), ranging from 32 to 49% in PD patients. Peritoneal transporter type plays an important role in the development of nutritional complications, where the high transporter compared to the slow or low transporter has been associated with a higher nutritional risk by increasing the risk of volume overload, hypertension, and inflammation; as well as greater loss of proteins in the dialysate due to the greater number of replacements that characterize its prescription. Nutrition specialists needs to consider diverse aspects to achieve an individualized nutritional approach based on the characteristics of the patient, where knowing peritoneal transporter type is essential. The aim of this study is to review the evidence available to date regarding nutritional therapy in patients with peritoneal dialysis, as well as to analyze some basic aspects of dialysis therapy.
El número de pacientes con enfermedad renal crónica avanzada/terminal (ERCT) con alguna modalidad de terapia de reemplazo renal (TRR) ha ido en ascenso. A nivel mundial, la diálisis peritoneal (DP) representa el 11% del total de pacientes con TRR. Las diferentes opciones de TRR se han asociado con un mayor riesgo para desarrollar complicaciones infecciosas, metabólicas y nutricionales, reportándose cifras alarmantes de desgaste proteico energético (DPE) que oscilan entre 32-49% en pacientes en DP. El tipo de transportador peritoneal juega un rol importante en el desarrollo de complicaciones nutricionales, donde el transportador alto, en comparación con el lento o bajo, se ha asociado con un mayor riesgo nutricional al incrementar el riesgo de sobrecarga de volumen, hipertensión e inflamación; así como mayor pérdida de proteínas en el dializado por el mayor número de recambios que caracteriza su prescripción. Por tal motivo, el profesional de la nutrición debe considerar diversos aspectos para lograr un abordaje nutricional individualizado a partir de las características del paciente, en el que conocer el tipo de transportador peritoneal es fundamental. El objetivo del presente trabajo es realizar una revisión de la evidencia disponible hasta la fecha respecto a la terapia nutricional del paciente con diálisis peritoneal, así como analizar algunos aspectos básicos de la terapia dialítica.