engleski

BLOOD FLOW RATE DURING HEMODIALYSIS AFFECTS MALNUTRITION-INFLAMMATION SCORE IN CHRONIC KIDNEY DISEASE PATIENTS

INTRODUCTION AND AIMS: Protein-energy wasting (PEW) is a state of decreased body stores of protein and fat masses which arises from inadequate nutrient intake and increased catabolism. Although the long-term exposure to dialyser membrane promotes inflammatory response, there is a growing body of evidence suggesting the usage of modern dialysis techniques could favorably affect the nutritional status. The primary aim of this study was to evaluate the link between hemodialysis (HD) treatment quality and the nutritional status in patients treated in UHC , , Zagreb“. METHODS: A total of 101 adult out-patients (56.4% male, mean age 60.8616.15 years) were enrolled in the study. Bicarbonate HD and ultrapure dialysate with flow rate of 500 ml/min was used for all patients. Clinical and laboratory data were obtained from the medical records and charts. Anthropometric measurements were performed prior to HD. Malnutrition-Inflammation Score (MIS) was used as a scoring system representing the severity of PEW. RESULTS: The mean time spent on HD was 96.036102.521 months, with a minimum treatment time of 3 hours for 2 to 4 times a week, and average Kt/V 1.3. According to statistical analysis, maximizing blood flows through the treatment contributed significantly to maintaining lean tissue index (LTI, p = 0.048) and thus improving MIS (p = 0.027). As a preferred vascular access, AVF not only showed higher blood flow rates as expected, but also seemed to have a beneficial effect on serum albumin (38.746 3.087 mg/L vs. 36.4176 3.285 mg/L, p = 0.001) and prealbumin (0.5686 0.148 mg/L vs. 0.4946 0.15m mg/L, p = 0.027) levels, suggesting an increase in protein stores. Longer HD ( 4 hours) was associated with higher “dry” body weight (72.3486 16.882 kg vs. 65.1496 16.795 kg, p = 0.044), mainly on the account of LTI (13.2646 3.027 kg/ m2 vs. 11.0076 2.558 kg/m2 , p = 0.001). Additionally, residual kidney function (daily diuresis > 300 ml) appeared not only to have clear benefits on MIS but also anthropometric measures linked to preserved fat stores (fat tissue index - FTI 13.691 6 5.529 kg/m2 vs. 11.071 6 4.757 kg/m2 , p = 0.017), with significant repercussion on higher BMI (27.119 6 6.132 kg/m2 vs. 23.5076 4.126 kg/m2 , p = 0.001). CONCLUSIONS: Results of our study demonstrate that HD treatment quality had an important impact on the parameters regarding nutritional status. If estimating dialysis adequacy through the elements of preferred Kt/V equation, it is evident that by improving blood flow rates or prolonging dialysis treatment we could be able to achieve better nutritional outcomes. While anticipating new and more effective measures for preventing PEW, our results clearly show that striving for highest possible dialysis quality should be one of the key strategies in improving the outcomes in this specific group of patients.

protein-energy wasting, hemodialysis, blood flow, treatment parameters

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