Publication: Evaluación de la función renal en pacientes con enfermedad renal crónica (ERC) sin tratamiento sustitutorio, tras un programa de intervención nutricional (PIN): estudio aleatorizado
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2016-11-22
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Universidad Complutense de Madrid
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Abstract
La Enfermedad Renal Crónica (ERC) se define como la disminución de la función renal, donde se reduce el filtrado glomerular (FG) estimado < 60 ml/min/1,73m2 o como la presencia de daño renal de forma persistente durante al menos tres meses. La enfermedad renal crónica (ERC) es una patología progresiva que afecta cada vez más a la población, el daño renal aumenta con el paso del tiempo, siendo su resultado el tratamiento renal sustitutivo, trasplante o incluso la muerte, el gran problema es que en ocasiones no hay síntomas hasta que esta instaurada. Las causas de la ERC son complejas e incluyen enfermedades comunes, como la hipertensión, el síndrome metabólico (conjunto de varios factores como HTA, obesidad), la diabetes y otras patologías que afectan al riñón. Desde la clasificación de ERC en 5 fases, los clínicos pueden diagnosticar precozmente, incluso en estadios iniciales. Para frenar la progresión de la enfermedad es recomendable la disminución de ingesta de proteica. El objetivo de este estudio es evaluar una intervención nutricional (PIN) sobre la función renal, valorando la ingesta, vigilando el estado renal y nutricional en pacientes con enfermedad renal crónica sin tratamiento sustitutorio. Se siguieron los criterios de las quías KDIGO/KDOQI, y los diferentes Documentos de Consenso de las Sociedades Científicas. Se diseñó un estudio longitudinal aleatorizado de 86 participantes, de los 43 que componían el grupo estudio (E) finalizaron el programa de intervención nutricional 90,69% de la muestra inicial, y 38 de los participantes del grupo control (C) (88,37%). La duración del ensayo fue de 12 meses. El estado nutricional se evaluó mediante la valoración global subjetiva (VSG), datos antropométricos, dietéticos y analíticos. Se realizó los análisis estadísticos con el programa SPSS. A los doce meses, se ha observado un aumento de FG y una disminución de otros parámetros que agravan la enfermedad. Además, se ha producido un control de la ingesta proteica y de la ingesta energética. Conclusión: Mediante una intervención nutricional mantenida en el tiempo, se puede controlar el estado nutricional y se evita la progresión de la enfermedad renal, influyendo positivamente en algunos parámetros de riesgo. Por lo que podemos concluir que la utilización de programas de intervención nutricional (PIN) en las consultas de enfermería nefrológica para pacientes con enfermedad renal crónica, podría evitar, en ocasiones, el paso del paciente a diálisis, trasplante o a la muerte.
Chronic Renal Failure (CRF) or better known as Chronic Kidney Failure (CKF) is defined as a progressive decrease of renal function where the glomerular filtration rate (GFR) < 60ml/min/1,73m2 or as the presence of persistent renal damage for at least 3 consecutive months. Chronic kidney failure (CKF) is a progressive disease that affects more and more people. Kidney damage increase over time with its result being renal replacement surgery, transplant or even in some cases death. The big problem is that sometimes there are no symptoms until it has been instituted. The causes of CKF are complicated and include common diseases like hypertension, metabolic syndrome (a conjunction of HT and obesity), diabetes and other pathologies that affect the kidneys. The classification of CKF is in 5 phases, even before clinical diagnosis at early stages. To slow the onset of the disease it is recommended to decrease protein intake. The aim of this study is to assess nutritional intervention programme (NIP) regarding renal function, assessing the intake and watching the renal and nutritional status in patients with chronic kidney disease without substitutional treatment. It is suggested to follow KDIGO/KDOQI criteria and different Scientific Societies Consensus Documents. A longitudinal study randomized 86 patients from which 43 made up the study group (E) whom completed the nutritional intervention programme 90.69% of the initial sample and 38 patients in the control group (C) (88.37%). The duration of the trial was 12 months. The nutritional status was evaluated under the Subjective Global Assessment (SGA), anthropometric values, dietary and analytical data. Statistical analysis using SPSS was established as well. At twelve months there was an observed increase of FG whereas on the other hand there was a decrease in other parameters that exacerbate the disease. Besides, there was a decrease in protein intake and no increase in energy intake. Conclusion: Through a nutritional intervention programme (during a given time) the nutritional status will improve whilst progressive kidney failure will be avoided and a positive values from some risk parameters will improve. The nutritional intervention programme is also very useful for the study of nephrology, regarding patients with chronic kidney failure, as in many instances it prevents the patient requiring dialysis, transplant or death.
Chronic Renal Failure (CRF) or better known as Chronic Kidney Failure (CKF) is defined as a progressive decrease of renal function where the glomerular filtration rate (GFR) < 60ml/min/1,73m2 or as the presence of persistent renal damage for at least 3 consecutive months. Chronic kidney failure (CKF) is a progressive disease that affects more and more people. Kidney damage increase over time with its result being renal replacement surgery, transplant or even in some cases death. The big problem is that sometimes there are no symptoms until it has been instituted. The causes of CKF are complicated and include common diseases like hypertension, metabolic syndrome (a conjunction of HT and obesity), diabetes and other pathologies that affect the kidneys. The classification of CKF is in 5 phases, even before clinical diagnosis at early stages. To slow the onset of the disease it is recommended to decrease protein intake. The aim of this study is to assess nutritional intervention programme (NIP) regarding renal function, assessing the intake and watching the renal and nutritional status in patients with chronic kidney disease without substitutional treatment. It is suggested to follow KDIGO/KDOQI criteria and different Scientific Societies Consensus Documents. A longitudinal study randomized 86 patients from which 43 made up the study group (E) whom completed the nutritional intervention programme 90.69% of the initial sample and 38 patients in the control group (C) (88.37%). The duration of the trial was 12 months. The nutritional status was evaluated under the Subjective Global Assessment (SGA), anthropometric values, dietary and analytical data. Statistical analysis using SPSS was established as well. At twelve months there was an observed increase of FG whereas on the other hand there was a decrease in other parameters that exacerbate the disease. Besides, there was a decrease in protein intake and no increase in energy intake. Conclusion: Through a nutritional intervention programme (during a given time) the nutritional status will improve whilst progressive kidney failure will be avoided and a positive values from some risk parameters will improve. The nutritional intervention programme is also very useful for the study of nephrology, regarding patients with chronic kidney failure, as in many instances it prevents the patient requiring dialysis, transplant or death.
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Enfermería, Fisioterapia y Podología, leída el 20/01/2016