Hypoproteinemia as a factor in assessing malnutrition and predicting survival on hemodialysis
Hypoproteinemia as a factor in assessing malnutrition and predicting survival on hemodialysis
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DOI：
10.1007/s10047-019-01098-3
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发表时间：
2019-09-01
影响因子：
1.3
通讯作者：
Jelakovic, Bojan
中科院分区：
文献类型：
--
作者：
Katalinic, Lea;Premuzic, Vedran;Jelakovic, Bojan
一系列研究将营养不良描述为与血液透析（HD）患者预后不良和治疗结果相关的主要非传统风险因素之一。本研究的目的是评估HD治疗质量与营养状况之间的联系，并进一步调查营养不良与总生存率之间的关系。研究共纳入134例成人门诊患者，其中男性56.4%，平均年龄60.8±16.15岁。临床和实验室数据来自医疗记录。在HD之前进行人体测量。营养不良-炎症评分（MIS）作为评分系统，代表蛋白质-能量浪费（PEW）的严重程度。与非营养不良的患者相比，营养不良的患者明显更老。他们有明显较长的透析时间和较低的残余利尿，BMI，血清蛋白，白蛋白和瘦组织指数（LTI）。营养不良患者的生存时间明显短于非营养不良患者。低蛋白血症患者血清白蛋白和LTI值明显低于正常蛋白血症患者，存活时间短。在所有患者组中，只有营养不良和年龄与较高的总死亡率相关。通过关注MIS和血清蛋白状态，而不是透析相关因素和不同的治疗技术，我们可以获得更好的营养状况和改善的整体疗效。在预测新的和更有效的预防营养不良措施的同时，我们的研究结果清楚地表明，争取尽可能高的营养状况应该是改善这一特定患者群体预后的关键策略之一。
Series of studies have described malnutrition as one of the main non-traditional risk factors associated with poor prognosis and treatment outcome in patients on hemodialysis (HD). The aims of this study were to evaluate the link between HD treatment quality and the nutritional status and to additionally investigate the association of malnutrition and overall survival. A total of 134 adult out-patients (56.4% male, mean age 60.8 +/- 16.15 years) were enrolled in the study. Clinical and laboratory data were obtained from the medical records. Anthropometric measurements were performed prior to HD. Malnutrition-Inflammation Score (MIS) was used as a scoring system representing the severity of protein-energy wasting (PEW). Malnourished patients were significantly older when compared to non-malnourished patients. They had significantly longer dialysis vintage and lower residual diuresis, BMI, serum proteins, and albumins and lean tissue index (LTI). Malnourished patients survived significantly shorter than non-malnourished patients. Hypoproteinemic patients had significantly lower values of serum albumins and LTI and survived shorter than normoproteinemic patients. Only malnourishment and age were associated with higher overall mortality in all groups of patients. By focusing on MIS and serum protein status rather than dialysis-related factors and different treatment techniques, we could accomplish better nutrition status and improved overall outcomes. While anticipating new and more effective measures for preventing malnutrition, our results clearly demonstrate that striving for the highest possible nutrition status should be one of the key strategies in improving the outcomes in this specific group of patients.