Publication: Determinantes de malnutrición en pacientes en hemodiálisis: efecto de la suplementación proteica oral intradiálisis
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2018-04-13
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Universidad Complutense de Madrid
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Abstract
La malnutrición es una de las complicaciones frecuentemente observadas en pacientes en diálisis con una prevalencia que oscila entre el 18 y 75% según diferentes estudios; y que se ha asociado con pobres resultados clínicos, entre ellos, una mayor mortalidad. Sus causas son múltiples y están relacionadas principalmente con la disminución de la ingesta, las condiciones comórbidas, así como por el procedimiento de diálisis en sí. La influencia del procedimiento de diálisis en el estado nutricional de los pacientes se ejerce principalmente por una alteración en el metabolismo de las proteínas: debido no sólo a la pérdida de nutrientes en el líquido de diálisis, sino también a un aumento en la degradación y una disminución en la síntesis proteica. En los últimos años se han propuesto diferentes medidas terapéuticas con el objetivo de mejorar el estado nutricional de estos pacientes; entre ellas, la administración de suplementos nutricionales orales intradiálisis se ha planteado como una estrategia válida e interesante. El fundamento que avala esta intervención se centra en que además de ser una fuente adicional de nutrientes, el administrar estos suplementos durante la diálisis generaría un incremento en los niveles de aminoácidos plasmáticos que ayudaría a prevenir el catabolismo muscular generado durante la misma. Además este tipo de intervención al ser controlada por el personal de las unidades de diálisis asegura la adherencia a la misma. El objetivo principal de nuestro estudio fue evaluar si la suplementación proteica oral intradiálisis consigue una mejora en el estado nutricional, determinado por el incremento en los niveles de prealbúmina, en los pacientes en hemodiálisis del Hospital Severo Ochoa. Como objetivos secundarios, buscamos evaluar si la intervención propuesta induce cambios en los distintos parámetros inflamatorios, nutricionales y de composición corporal. Y finalmente, analizamos si la suplementación proteica oral intradiálisis tiene efecto sobre la supervivencia en nuestra cohorte...
Malnutrition is one of the many complications frequently observed in dialysis patients, with a prevalence ranging between 18 and 75% according to different studies, and it has been associated with poor clinical outcomes, including increased mortality. The causes or malnutrition in this population are many and mainly related to decreased food intake, comorbid conditions, and to the dialysis procedure itself. The influence of the dialysis procedure in the nutritional status of these patients is mainly exerted by an alteration in the protein metabolism: due not only to the loss of nutrients in the dialysis fluid, but also to an increased degradation and decreased synthesis of proteins. In the last years, different therapeutic strategies have been proposed with the aim of improving the nutritional status of dialysis patients; among those, the administration of oral nutritional supplements during the dialysis sessions has been advised as a valid and interesting strategy. The rationale supporting this intervention is that apart from being an additional source of nutrients, to provide the oral supplementation during the dialysis procedure would generate an increase in plasmatic amino acids levels which might help to prevent the muscle catabolism generated during it. Furthermore, since this type of intervention is controlled by the dialysis staff, the adherence is ensured. The main objective of our study was to evaluate whether intradialytic oral protein supplementation achieves an improvement in the nutritional status determined by the increase in prealbumin levels in hemodialysis patients at Severo Ochoa Hospital. As secondary objectives, we investigated whether the proposed intervention induces changes on various nutritional, inflammatory and body composition parameters. Finally, we assessed whether intradialytic oral protein supplementation has an effect on the survival in our cohort...
Malnutrition is one of the many complications frequently observed in dialysis patients, with a prevalence ranging between 18 and 75% according to different studies, and it has been associated with poor clinical outcomes, including increased mortality. The causes or malnutrition in this population are many and mainly related to decreased food intake, comorbid conditions, and to the dialysis procedure itself. The influence of the dialysis procedure in the nutritional status of these patients is mainly exerted by an alteration in the protein metabolism: due not only to the loss of nutrients in the dialysis fluid, but also to an increased degradation and decreased synthesis of proteins. In the last years, different therapeutic strategies have been proposed with the aim of improving the nutritional status of dialysis patients; among those, the administration of oral nutritional supplements during the dialysis sessions has been advised as a valid and interesting strategy. The rationale supporting this intervention is that apart from being an additional source of nutrients, to provide the oral supplementation during the dialysis procedure would generate an increase in plasmatic amino acids levels which might help to prevent the muscle catabolism generated during it. Furthermore, since this type of intervention is controlled by the dialysis staff, the adherence is ensured. The main objective of our study was to evaluate whether intradialytic oral protein supplementation achieves an improvement in the nutritional status determined by the increase in prealbumin levels in hemodialysis patients at Severo Ochoa Hospital. As secondary objectives, we investigated whether the proposed intervention induces changes on various nutritional, inflammatory and body composition parameters. Finally, we assessed whether intradialytic oral protein supplementation has an effect on the survival in our cohort...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 06/02/2017