Sürekli Ayaktan Periton Diyaliz Hastalarında Peritonit ile Diyaliz Yetersizliği ve Nutrisyonel Parametrelerin İlişkisi

Öz

Amaç: KBH hastalarında malnütrisyon mortalite artışının önemli bir nedenidir. Malnütrisyon gelişiminde ise en önemli neden diyaliz yetersizliğidir. SAPD Sürekli Ayaktan Periton Diyaliz hastalarında peritonit en önemli komplikasyon olmakla birlikte, diyaliz yetersizliği ve malnütrisyona neden olabileceği için önemi daha da artmaktadır. Malnütrisyon ve diyaliz yetersizliğinin erken tanınıp tedavi edilmesi mortaliteyi azaltacağı için peritonit sıklığı ile malnütrisyon ve diyaliz yetersizliği ilişkisinin araştırılması amaçlandı. Gereç ve Yöntemler: Çalışmaya 60 SAPD hastası alındı. Hastalar yıllık peritonit sıklığına göre iki gruba ayrıldı. Yılda iki veya daha fazla sayıda peritonit atağı geçiren hastalar yüksek peritonit indeksli HPI yılda bir veya hiç peritonit geçirmeyenler ise düşük peritonit indeksli LPI olarak gruplandırıldı. 34 %56,67 hasta LPI, 26 %43,33 hasta HPI grubuna dahil edildi. İki grup haftalık toplam KT/V üre, toplam kreatinin klirensi, rezidüel renal fonksiyon RRF , günlük protein alımı DPI , protein katabolizma hızı PCR , serum transferin ve albümin düzeyleri açısından karşılaştırıldı. Bulgular: Her iki grupta KT/V, klirensi, RRF, DPI, PCR ve serum transferin düzeylerinde anlamlı fark saptanmamıştır. Serum albümin düzeyinin HPI grubunda anlamlı düzeyde düşük olduğu saptanmıştır 3,84±0,52 ve 4,24±0,65, p:0,040 . HPI grubunda peritoneal albümin kaybı daha fazla olmasına rağmen istatistiksel anlam taşımamaktadır p:0,260 .Sonuç: Peritonit sıklığı önemli bir etken olsa da tek başına malnütrisyon ya da diyaliz yetersizliğini belirleyen bir faktör olmadığını, hastanın diyetle alım eksikliği, diyaliz süresi, kullanılan diyalizatın kronik peritoneal toksisitesi, diyabet gibi sistemik hastalıklarla birlikte değerlendirilmesi gerektiğini düşünmekteyiz

Anahtar Kelimeler

• SAPD, Peritonit, Malnütrisyon, Diyaliz yetersizliği

Relationship of Dialysis Failure and Nutritional Parameters with Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients

Abstract

Objective: Malnutrition is an important risk for increased mortality rate in Chronic Renal Disease CRD patients. Dialysis failure is the leading cause of malnutrition. Peritonitis is the most important complication of CAPD Continuous Ambulatory Peritoneal Dialysis treatment and has become more important because of increasing risk of dialysis failure and malnutrition. Early detection and treatment of dialysis failure and malnutrition decrease mortality. We therefore aimed to search for the relationship between dialysis failure and nutritional parameters and the frequency of peritonitis.Material and Methods: A total of 60 CAPD patients were included in this study. The patients were divided into two groups according to their peritonitis frequency. Patients with two or more peritonitis attacks were grouped as High Peritonitis Index HPI and those with one or no peritonitis attacks as Low Peritonitis Index LPI . 34 56.67% patients were in the LPI and 26 43.33% in the HPI group. These two groups were compared according to their weekly KT/V, clearance, residual renal function RRF , daily protein intake DPI , protein catabolism rate PCR , and serum transferrin and albumin levels Results: There was no signifi cant difference for KT/V, clearance, RRF, DPI, PCR and serum transferrin levels. The serum albumin level was signifi cantly lower in the HPI group 3.84±0.52 vs. 4.24±0.65, p:0.04 . The total loss of albumin in the dialysate was higher in the HPI group but there was no statistical signifi cance p: 0.26 . Conclusion: Peritonitis frequency is an important factor but not a determinant for malnutrition and dialysis failure by itself. Our results show that patients' dietary intake defi ciency, duration of dialysis, chronic peritoneal toxicity of the used dialysate, or any systemic disease like diabetes should be evaluated together with the peritonitis frequency.

Keywords

• CAPD, Peritonitis, Dialysis failure, Malnutrition

References

1. Williams L, Douglas C, Bonner A, Williams N, Ranganathan D. A clinical audit to compare peritonitis rates between peritoneal dialysis delivery systems. Renal Society of Australasia Journal 2015;11(2): 68.
2. Sei Y, Mizuno M, Suzuki Y, Imai M, Higashide K, Harris CL, Maruyama S. Expression of membrane complement regulators, CD46, CD55 and CD59, in mesothelial cells of patients on peritoneal dialysis therapy. Molecular Immunology 2015;65(2): 302-309.
3. Kovesdy Csaba P. Malnutrition in dialysis patients-the need for intervention despite uncertain benefi ts. Seminars in Dialysis 2016;29(1):28-34.
4. He T, An X, Mao HP, Wei X, Chen JH, Guo N, Yang X, Li ZB, Yu XQ , Li ZJ. Malnutrition-infl ammation score predicts long-term mortality in Chinese PD patients. Clinical Nephrology 2013;79(6):477-83.
5. Fein PA, Weiss S, Avram MM, Ramos F, Singh P, See SY, Shahzadi M, Chattopadhyay J. Relationship of normalized protein catabolic rate with nutrition status and long-Term survival in peritoneal dialysis patients. Advances in Peritoneal Dialysis 2015;31:45-8.
6. Garibotto G, Sofi a A, Saffi oti S, Bonanni A, Mannucci I, Parodi EL, Cademartori V, Verzola D. Effects of peritoneal dialysis on protein metabolism. Nutrition, Metabolism and Cardiovascular Diseases 2013;23(1): 25-30.
7. Avel VA, Molnar MZ, Streja E, Kim JC, Victoroff A, Jing J, Kalantar-Zadeh K. Low protein nitrogen appearance as a surrogate of low dietary protein intake is associated with higher all-cause mortality in maintenance hemodialysis patients. The Journal of Nutrition 2013;143(7):1084-92.
8. Naoki K, Angelo K, Brian AB, Ronald LP, Hal M, Brenda WG, Akira S, Tadao A, Shunichi F, Bruce MR, Friedrich KP, Takashi AG. Low Kt/V, and mortality in Japanese hemodialysis patients: Opportunities for improvement through modifi able practices. Hemodialysis International 2014;18(3): 596-606.

9. Sarıkaya M, Şahintürk Y, İnci A. Sürekli ayaktan periton diyaliz hastalarında peritonit ve serum-diyalizat immünglobulin düzeyi ilişkisi. Türk Nefroloji Diyaliz Transplantasyon Dergisi 2017;26(2): 204-8.
10. Bergström J, Fürst P, Alvestrand A, Lindholm B. Protein and energy intake, nitrogen balance and nitrogen losses in patients treated with continuous ambulatory peritoneal dialysis. Kidney International 1993;44(5): 1048-57.
11. Bruno C, Giuliano B, Joel DK, Giacomo T, Giacomo P, Giuseppe E, Paolo S, Amedeo DV, Mario Q , Giusto V, Edward V, Rosario M. Cross-sectional comparison of malnutrition in continuous ambulatory peritoneal dialysis and hemodialysis patients. American Journal of Kidney Diseases 1995;26(3): 475-86.
12. Vincenzo P, Adamasco C, Alberto R, Adriana DG, Alessia S, Ophelia M, Laura B, Anna B. Geriatric nutritional risk index is a strong predictor of mortality in hemodialysis patients: data from the Riscavid cohort. Journal of Nephrology 2014;27(2): 193-201.
13. Ren H, Xie J, Li X, Huang X, Zhang C, Chen N. Nutritional assessment of CAPD patients. Kidney Research and Clinical Practice 2012; 31(2): A68.
14. Dalrymple LS, Johansen KL, Chertow GM, Grimes B, Anand S, McCulloch CE, Kaysen GA. Longitudinal measures of serum albumin and prealbumin concentrations in incident dialysis patients: the comprehensive dialysis study. Journal of Renal Nutrition 2013; 23(2): 91-7.
15. Szeto CC. Adequacy of Peritoneal Dialysis in Terms of Small Solute Clearance-The Evolving Concept. Artifi cial Organs 2016; 40(3): 221-4.
16. Fox L, Tzamaloukas AH, Murata GH. Metabolic differences between persistent and routine peritonitis in CAPD. Adv Perit Dial 1992;346(8): e50.
17. Moreno M, Martın A, Yrıbarren M, Alvarez A. Status of nutrition in uremic patients treated with outpatient continuous peritoneal dialysis relation with evolution of one year. Mediciana Clinica 1991;97(17): 650-4.
18. Struijk DG, Krediet RT, Koomen GC, Boeschoten EW, Arisz L. The effect of serum albumin at the start of continuous ambulatory peritoneal dialysis treatment on patient survival. Peritoneal Dialysis International 1994; 14(2): 121-6.
19. Davies SJ, Bryan J, Phillips L, Russell GI. Longitudinal changes in peritoneal kinetics: The effects of peritoneal dialysis and peritonitis. Nephrology Dialysis Transplantation 1996;11(3): 498-506.
20. Kostić S, Velicković R, Ljubenović S, Raicević R, Stefanović V, Veljković S, Cukuranović R, Radenković S, Djordjević V, Antić S.. The effect of frequent peritonitis on parameters of effi cacy of peritoneal dialysis. Srpski Arhiv za Celokupno Lekarstvo 1995;124: 153-5.
21. Blake PG, Abraham G, Sombolos K, Izatt S, Weissgarten J, Ayiomamitis A, Oreopoulos DG. Changes in peritoneal membrane transport rates in patients on long term CAPD. Adv Perit Dial 1989;5: 3-7.
22. Lo WK, Brendolan A, Prowant BF, Moore HL, Khanna R, Twardowski ZJ, Nolph, KD. Changes in the peritoneal equilibration test in selected chronic peritoneal dialysis patients. Journal of the American Society of Nephrology 1994;4(7): 1466-74.
23. Passlick-Deetjen J, Chlebowski H, Koch M, Grabensee B. Changes of peritoneal membrane function during long- term CAPD. Adv Perit Dial 1990; 6: 35-43.