Publication: Análisis de la composición corporal por bioimpedancia espectroscópica en pacientes trasplantados renales. Factores relacionados con la sobrehidratación y el exceso de masa grasa e impacto clínico de los mismos
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2017-02-23
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Universidad Complutense de Madrid
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Abstract
INTRODUCCIÓN. Los pacientes trasplantados renales tienen un riesgo cardiovascular superior al de la población general. El exceso de masa grasa y en relación con ella la presencia de trastornos del metabolismo de glucosa y lípidos, así como la sobrehidratación, conduccente a la sobrecarga cardiaca, son más prevalentes en los pacientes trasplantados renales que en la población general y pueden influir en su riesgo incrementado de morbimortalidad cardiovascular. Debido a esto, es de suma importancia la precoz detección de estas alteraciones para poder actuar sobre ellas y disminuir los eventos cardiovasculares. Para ello, se dispone en el momento actual de medidas indirectas de aterogenicidad como la determinación de glucemia y lípidos en plasma, el índice de masa corporal (IMC), y la exploración física en busca de edemas. Estas medidas tienen menor sensibilidad que las modernas técnicas como la bioimpedancia espectroscópica (BIE) para la detección precoz de alteraciones en la cantidad de grasa y/o agua corporal. Entre los distintos procedimientos para estudiar la composición corporal, la BIE ocupa un lugar destacado por su sencillez, bajo coste, inmediatez, capacidad de repetición e inocuidad para el sujeto que es sometido a examen. Sin embargo, así como en pacientes con enfermedad renal crónica (ERC) con o sin necesidad de tratamiento sustitutivo renal (TRS), son numerosos los trabajos que confirman la influencia de la sobrehidratación y el exceso de masa grasa sobre el riesgo cardiovascular, son escasas las publicaciones al respecto en pacientes trasplantados renales. El conocimiento de la influencia de la composición corporal por métodos más exactos que las medidas antroprométricas habitualmente utilizadas, puede determinar decisiones terapéuticas tales como minimización o retirada precoz de tratamiento esteroideo, optimización de tratamiento diurético y modificaciones en los consejos higiénicodietéticos, que consigan disminuir la morbimortalidad cardiovascular de los pacientes trasplantados renales sin comprometer el pronóstico funcional del injerto...
INTRODUCTION. Renal transplant patients have a higher overall cardiovascular risk compared to general population. Excessive fat mass associated with disorders of glucose and lipid metabolism, as well as overhydration, leading to cardiac overload, are more prevalent in renal transplant patients than in general population and may influence their increased risk of cardiovascular morbidity and mortality. Because of this, it is crucial the early detection of these alterations to act on them and reduce cardiovascular events. To do this, we currently use indirect measures of atherogenicity as plasma glucose and lipids, body mass index (BMI), and physical examination in search of edema. These measures are less sensitive than modern techniques such as bioimpedance spectroscopy (BIS) for early detection of changes in the amount of fat and / or body water. Among the different methods to study body composition, BIS is one of the most interesting because of its simplicity, low cost, immediacy, reproducibility and safety for the patient. However, in contrast with patients with chronic kidney disease (CKD) with or without renal replacement therapy (RRT), on which numerous studies confirm the influence of overhydration and excessive body fat on cardiovascular risk, few relevant publications on this associations are available in kidney trasplantation. The exact knowledge of the influence of body composition by more accurate instruments, can determine treatment decisions such as minimization or early withdrawal of steroid therapy, optimized diuretic therapy and changes in hygiene and dietary advice, to achive lower cardiovascular morbidity and mortality in renal transplant patients without compromising the graft function...
INTRODUCTION. Renal transplant patients have a higher overall cardiovascular risk compared to general population. Excessive fat mass associated with disorders of glucose and lipid metabolism, as well as overhydration, leading to cardiac overload, are more prevalent in renal transplant patients than in general population and may influence their increased risk of cardiovascular morbidity and mortality. Because of this, it is crucial the early detection of these alterations to act on them and reduce cardiovascular events. To do this, we currently use indirect measures of atherogenicity as plasma glucose and lipids, body mass index (BMI), and physical examination in search of edema. These measures are less sensitive than modern techniques such as bioimpedance spectroscopy (BIS) for early detection of changes in the amount of fat and / or body water. Among the different methods to study body composition, BIS is one of the most interesting because of its simplicity, low cost, immediacy, reproducibility and safety for the patient. However, in contrast with patients with chronic kidney disease (CKD) with or without renal replacement therapy (RRT), on which numerous studies confirm the influence of overhydration and excessive body fat on cardiovascular risk, few relevant publications on this associations are available in kidney trasplantation. The exact knowledge of the influence of body composition by more accurate instruments, can determine treatment decisions such as minimization or early withdrawal of steroid therapy, optimized diuretic therapy and changes in hygiene and dietary advice, to achive lower cardiovascular morbidity and mortality in renal transplant patients without compromising the graft function...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 01/02/2016