Yaşlı Hemodiyaliz Hastalarında Malnütrisyon Değerlendirmesi; Tek Merkez Verileri/Malnutrition Evaluation in Elderly Hemodialysis Patients; Single Center Data

Yıl 2021, Cilt: 16 Sayı: 3, 160 - 168, 30.09.2021

Funda Datlı Yakaryılmaz , İrem Pembegül , Özgül Balseven

https://doi.org/10.47565/ndthdt.2021.44

Öz

Amaç: Tüm dünyada olduğu gibi ülkemizde de yaşlı nüfusun artışıyla hemodiyaliz tedavisi alan yaşlı hasta sayısı artmaktadır. Yaşlı hemodiyaliz hastalarında beslenme sorunları mortalite ve morbiditeyi arttırdığı için erken dönemde tanı konulması ve tedaviye başlanması büyük öneme sahiptir. Bu çalışma hemodiyaliz tedavisi alan yaşlı hastalarda yetersiz beslenme prevalansını belirlemek ve Mini Nütrisyonel DeğerlendirmeKısa Formu ile vücut kütle indeksinin beslenme yetersizliği olan hastalardaki etkinliğini değerlendirmek amacıyla yapıldı. Gereç ve Yöntem: Bu kesitsel çalışmaya 65 yaş ve üstü, 66’sı (69,24±5,68) erkek ve 57’si (71.01±7.50) kadın toplam 123 hasta dahil edildi. Hastalara ait antropometrik, klinik ve laboratuvar verilere tıbbi dosyalardan ulaşıldı. Hastalar Mini Nütrisyonel Değerlendirme-Kısa Formu ve vücut kütle indeksi ile değerlendirildi. Bulgular: Mini Nütrisyonel Değerlendirme-Kısa Formuna göre 44 (%35,7) hastada malnütrisyon, 53 (%43,1) hasta malnütrisyon, yönünden riskli, 26 (%21,2) hasta normal beslenme durumu olarak değerlendirildi. Her üç grup arasında vücut ağırlığı ve vücut kitle indeksi açısından istatistiksel olarak anlamlı fark saptandı (sırasıyla; p<0.001, p<0.001). Çalışmaya katılan hastaların 45(%36,6)’inin vücut kitle indeksi <23 hesaplandı. Mini Nütrisyonel Değerlendirme-Kısa Formu ile vücut kitle indeksi ve kilo arasında pozitif korelasyon saptandı (sırasıyla; r= 0.701, p<0.001 ve r=0.612, p<0.001).
Sonuç: Hemodiyaliz hastalarında vücut kitle indeksi ile malnütrisyon arasında güçlü bir anlamlı ilişki olmasına rağmen, vücut kitle indeksinin tek başına kullanımı malnütrisyon tanısı koymada yetersiz kalmaktadır. Yaşlı hemodiyaliz hastalarında beslenme durum değerlendirmesinde vücut kitle indeksi tek başına değil, Mini Nütrisyonel Değerlendirme-Kısa Formu gibi geçerliliği ve güvenilirliği kanıtlanmış tarama testleri ile birlikte  kullanılmalıdır.

Anahtar Kelimeler

yaşlı, hemodiyaliz, malnutrisyon, MNA-SF;VKİ

Destekleyen Kurum

yok

Malnutrition Evaluation in Elderly Hemodialysis Patients; Single Center Data

Öz

Aim: With the increase in the elderly population in our country, as in the whole world, the number of elderly patients receiving hemodialysis treatment is increasing. Since nutritional problems
increase mortality and morbidity in elderly hemodialysis patients, early diagnosis and initiation of treatment are of great importance. Our aim; In addition to determining the prevalence of malnutrition in elderly patients receiving hemodialysis treatment, we aimed to evaluate the effectiveness of MiniNutritional Assessment-Short Form (MNA-SF) and body mass index (BMI) tests in identifying patients with nutritional deficiency. Materials and Method: A total of 123 patients aged 65 and over, 66 (69.24±5.68) men and 57 (71.01±7.50) women, were included in this cross-sectional study. Anthropometric, clinical and laboratory data of the patients were obtained from medical files. Patients were evaluated with Mini-Nutritional AssessmentShort Form and body mass index. Results: According to Mini-Nutritional Assessment-Short Form, 44 (35.7%) patients were considered malnutrition, 53 (43.1%) patients were at risk for malnutrition, and 26 (21.2%) patients were
considered to have a normal nutritional status. A statistically significant difference was found between all three groups in terms of weight and body mass index (respectively; p<0.001, p<0.001).
Body mass index <23 was calculated for 45 (36.6%) of the patients participating in the study. A positive correlation was found between Mini-Nutritional Assessment-Short Form and body mass index and weight (respectively; r= 0.701, p<0.001 and r=0.612, p<0.001). Conclusion: Although there is a strong and significant relationship between body mass index and malnutrition in hemodialysis patients, the use of body mass index alone is insufficient to diagnose malnutrition. In the evaluation of nutritional status in elderly hemodialysis patients, body mass index should not be used alone,
but should be used together with screening tests with proven validity and reliability such as Mini-Nutritional Assessment-Short Form.

Anahtar Kelimeler

elderly, hemodialysis, malnutrition, MNA-SF;BMI

Kaynakça

• 1. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. ESPEN Guideline 2017;36:49–64. http://dx.doi.org/10.1016/j.clnu.2016.09.004
• 2. Cakmak G, Öztürk ZA. Comparison of malnutrition assessment tools in terms of revealing the relationship between polypharmacy and inappropriate drug use and malnutrition. Progress in Nutrition. 2021; 210 DOI https://doi.org/10.23751/ pn.v23i2.11229
• 3. Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. Validation of the Mini Nutritional Assessment shortform (MNA®-SF): A practical tool for identification of nutritional status. The Journal of Nutrition, Health & Aging. 2009;13(9):782–788. doi: 10.1007/s12603-009-0214-7.
• 4. Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: Developing the Short-Form Mini-Nutritional Assessment (MNA-SF). The Journals of Gerontology. Series a, Biological Sciences and Medical Sciences. 2001;56(6):366–372. DOI: 10.1093/gerona/56.6.m366
• 5. Ng WL , Collins PF, Hickling DF , Bell JJ . Evaluating the concurrent validity of body mass index (BMI) in the identification of malnutrition in older hospital inpatients. Clin Nutr. 2019; 38(5):2417-2422. doi: 10.1016/j.clnu.2018.10.025.
• 6. Sarikaya D, Halil M, Kuyumcu ME, Kilic MK, Yesil Y, Kara O, ve ark. Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Archives of Gerontology and Geriatrics. 2015;61(1):56-60. doi: 10.1016/j.archger.2015.04.006.
• 7. Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, ve ark. Validation of the Mini Nutritional Assessment shortform (MNA-SF): a practical tool for identification of nutritional status. The Journal of Nutrition, Health & Aging. 2009;13(9):782-8. https://doi.org/10.1007/s12603-009-0214-7.
• 8. Uy MC, Lim-Alba R, Chua E. Association of dialysis malnutrition score with hypoglycemia and quality of life among patients with diabetes on maintenance hemodialysis. Journal of the ASEAN Federation of Endocrine Societies. 2018; 33(2): 137–145. DOI: 10.15605/jafes.033.02.05
• 9. Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, ve ark. Etiology of the protein-energy wasting syndrome in chronic kidney disease: A consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). Journal of Renal Nutrition. 2013; 23(2): 77–90. doi: 10.1053/j.jrn.2013.01.001.
• 10. Sahathevan S, Khor BH, Ng HM, Gafor AHA, Mat Daud ZA, Mafra D, ve ark. Understanding development of malnutrition in hemodialysis patients: a narrative review. Nutrients. 2020;12(10):3147. doi: 10.3390/nu12103147.
• 11. Bilgic A, Akgul A, Sezer S, Arat Z, Ozdemir FN, Haberal M. Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients. Journal of Renal Nutrition. 2007;17(6):381–8. DOI: 10.1053/j.jrn.2007.08.008
• 12. Kwon YE, Kee YK, Yoon CY, Han IM, Han SG, Park KS, ve ark. Change of nutritional status assessed using subjective global assessment is associated with all-cause mortality in ıncident dialysis patients. Medicine. 2016;95(7):e2714. doi: 10.1097/MD.0000000000002714
• 13. Afsar B, Sezer S, Arat Z, Tutal E, Ozdemir FN, Haberal M. Reliability of mini nutritional assessment in hemodialysis compared with subjective global assessment. Journal of Renal Nutrition. 2006;16(3):277–82. doi: 10.1053/j.jrn.2006.01.012.
• 14. Tsai AC, Chang MZ. Long-form but not short-form Mini-Nutritional Assessment is appropriate for grading nutritional risk of patients on hemodialysis--a cross-sectional study. International Journal of Nursing Studies. 2011;48(11):1429-35. doi: 10.1016/j.ijnurstu.2011.05.004.
• 15. Brzosko S, Hryszko T, Klopotowski M, Mysliwiec M. Validation of Mini Nutritional Assessment Scale in peritoneal dialysis patients. Archives of Medical Science. 2013;9(4):669–76. DOI: https://doi.org/10.5114/aoms.2012.31386
• 16. Santin FG, Bigogno FG, Dias Rodrigues JC, Cuppari L, Avesani CM. Concurrent and predictive validity of composite methods to assess nutritional status in older adults on hemodialysis. Journal of Renal Nutrition. 2016;26(1):18–25. doi: 10.1053/j.jrn.2015.07.002.
• 17. Holvoet E, Vanden Wyngaert K, Van Craenenbroeck AH, Van Biesen W, Eloot S. The screening score of Mini Nutritional Assessment (MNA) is a useful routine screening tool for malnutrition risk in patients on maintenance dialysis. PLoS One. 2020;4;15(3):e0229722. doi: 10.1371/journal.pone.0229722.
• 18. Mahjoub F, Mizouri R, Ben Amor N, Bacha MM, Khedher A, Lahmar I., et al. Prevalence of malnutrition for elderly hemodialysis patients. Tunis Med. 2019;97(4):588-594. PMID: 31729710
• 19. Joint WHO/FAO Expert Consultation on Diet Nutrition and the Prevention of Chronic Diseases. Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation. World Health Organization, Geneva (2003) erişim: http://www.fao.org/3/ac911e/ac911e00.htm Erişim Tarihi: 01.06.2021
• 20. Mafra D, Farage NE, Azevedo DL, Vianna GG, Mattos JP, Velarde LG, et al. Impact of serum albumin and body-mass index on survival in hemodialysis patients. International Urology and Nephrology. 2007;39(2):619-24. doi: 10.1007/s11255-007- 9201-2.
• 21. Beberashvili I, Sinuani I, Azar A, Yasur H, Feldman L, Efrati S, Averbukh Z, Weissgarten J. Nutritional and inflammatory status of hemodialysis patients in relation to their body mass index. Journal of Renal Nutrition. 2009;19(3):238-47. doi: 10.1053/j.jrn.2008.11.007.
• 22. de Mutsert R, Snijder MB, van der Sman-de Beer F, Seidell JC, Boeschoten EW, Krediet RT, et al. Association between body mass index and mortality is similar in the hemodialysis population and the general population at high age and equal duration of follow-up. Journal of the American Society of Nephrology. 2007; 18(3):967-74. doi: 10.1681/ASN.2006091050.
• 23. Vashistha T, Mehrotra R, Park J, Streja E, Dukkipati R, Nissenson AR, et al. Effect of age and dialysis vintage on obesity paradox in long-term hemodialysis patients. American Journal of Kidney Diseases. 2014; 63(4):612-622. https://doi.org/10.1053/j.ajkd.2013.07.021
• 24. Lu JL, Kalantar-Zadeh K, Ma JZ, Quarles LD, Kovesdy CP. Association of body mass index with outcomes in patients with CKD. Journal of the American Society of Nephrology. 2014;25(9):2088–96. doi: 10.1681/ASN.2013070754.
• 25. Obermayr RP, Temml C, Gutjahr G, Kainz A, Klauser-Braun R, Függer R, et al. Body mass index modifies the risk of cardiovascular death in proteinuric chronic kidney disease. Nephrology Dialysis Transplantation. 2009;24(8):2421–8. doi: 10.1093/ndt/gfp075.
• 26. Leal VO, Moraes C, Stockler-Pinto MB, Lobo JC, Farage NE, Velarde LG, et al. Is a body mass index of 23 kg/m a reliable 2 marker of protein-energy wasting in hemodialysis patients? Nutrition. 2012;28(10):973-7. doi: 10.1016/j.nut.2011.12.004.
• 27. Wong JS, Port FK, Hulbert-Shearon TE, Carroll CE, Wolfe RA, Agodoa LY, et al. Survival advantage in Asian American endstage renal disease patients. Kidney International 1999; 55(6): 2515–2523. doi: 10.1046/j.1523-1755.1999.00464.x.
• 28. Hanna RM, Ghobry L, Wassef O, Rhee CM, Kalantar-Zadeh K. A Practical approach to nutrition, protein-energy wasting, sarcopenia, and cachexia in patients with chronic kidney disease. Blood Purification. 2020;49(1-2):202-211. doi: 10.1159/ 000504240.