Böbrek transplantli bireylerde beslenme takibi için CONUT skoru

Öz

Amaç: Kronik böbrek hastalığı hastanın nutrisyonel durumunu bozmaktadır. Nakil bu tabloyu sıklıkla düzeltir. Çalışmamızda böbrek transplantı olan bireylerde nutrisyonel durumu değerlendirmek için kontrol beslenme durumu (CONUT) skorunu değerlendirmeyi amaçladık. Gereç ve yöntem: Böbrek nakli olan bireyleri takip eden Nefroloji bilim dalından gelen verileri kullanarak, 188 bireyin CONUT skorunu hesaplamayı amaçladık. Laboratuvar bilgi sisteminde en az bir kez ölçülmüş, lenfosit sayısı, total kolesterol ve albümin düzeyleri olan nakilli bireylerini dahil ettik. Lenfosit sayısı ve toplam kolesteroldeki azalma 0, 1, 2 ve 3 puanla, albümin azalması ise hastalığın şiddetine göre 0, 2, 4 ve 6 puanla belirlendi. Hastalar bu skora göre normal, hafif, orta ve ağır olarak sınıflandırıldı. Bulgular: Normal grupta 130, hafif grupta 54, orta grupta 3 ve ağır grupta bir hasta vardı. CONUT skoru normal kilolu hastalar için hem nakil öncesinde hem de sonrasında iyiydi. Tüm laboratuvar bulguları CONUT grupları arasında anlamlı fark olduğunu ortaya koydu (p<0,05). Sonuç: Transplantasyon sonrası normal kilolu ve obez birey sayısı artarken, az kilolu hasta sayısı azaldı. CONUT skoru transplante hastaların beslenme durumunu izlemede etkin bir araç olarak öne sürülebilir.

Anahtar Kelimeler

• Böbrek nakli
• nutrisyonel durum
• klinik laboratuvar testleri
• risk skorlama

Controlling nutritional (CONUT) score for nutritional screening in kidney transplant recipients

Öz

Purpose: Nutrition is severely impaired in individuals with renal impairment, and transplant often ameliorates this condition. In this study, we aimed to evaluate the controlling nutritional status (CONUT) score of kidney transplant (KT) recipients. Materials and methods: Using the data from the nephrology transplant unit, we analyzed 188 patients whose data on the constituents of the CONUT score were available. We included KT individuals with at least one lymphocyte count and total cholesterol and albumin concentrations. This data has been used to calculate the CONUT score. The decrease of lymphocyte counts, and total cholesterol was determined with 0, 1, 2, and 3 points, and the reduction of albumin was assigned with 0, 2, 4, and 6 points in agreement with disease severity. Patients were classified according to this score: normal, light, moderate, and severe. Results: There were 130 patients in normal, 54 in light, and three in moderate and one in severe group. The CONUT score was good for regular-weight patients both before and after transplantation. All laboratory findings revealed significant differences between CONUT groups (p<0.05). Conclusion: After transplantation, the number of patients in the underweight group decreased when normal weight and obesity increased. However, some patients’ nutrition was not ameliorated. The CONUT score may be a useful tool for monitoring transplant patients’ nutritional status.

Anahtar Kelimeler

• Kidney transplantation
• nutrition process
• clinical laboratory test
• risk scores

Kaynakça

1. 1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3:4. https://doi.org/10.1038/kisup.2012.76
2. 2. Çiçek EA, Rota S, Dursun B, Kavalci E. Evaluation of serum NGAL and hepcidin levels in chronic kidney disease patients. Ren Fail 2016;38:35-39. https://doi.org/10.3109/0886022X.2015.1107823
3. 3. Munib S, Ahmed T, Ahmed R, NUD. Renal allograft biopsy findings in live-related renal transplant recipients. J Coll Physicians Surg Pak 2021;31:197-201. https://doi.org/10.29271/jcpsp.2021.02.197
4. 4. Allawi AAD. Malnutrition, inflamation and atherosclerosis (MIA syndrome) in patients with end stage renal disease on maintenance hemodialysis (a single centre experience). Diabetes Metab Syndr 2017;12:91-97. https://doi.org/10.1016/j.dsx.2017.09.003
5. 5. Keshavarz Shahbaz S, Pourrezagholi F, Nafar M, et al. Dynamic variation of kidney injury molecule-1 mRNA and protein expression in blood and urine of renal transplant recipients: a cohort study. Clin Exp Nephrol 2019;23:1235-1249. https://doi.org/10.1007/s10157-019-01765-y
6. 6. Veroux M, Corona D, Sinagra N, et al. Nutrition in kidney transplantation. Int J Artif Organs 2013;36:677-686. https://doi.org/10.5301/ijao.5000234
7. 7. Marino LV, Romão EA, Chiarello PG. Nutritional status, energy expenditure, and protein oxidative stress after kidney transplantation. Redox Rep. 2017;22:439-444. https://doi.org/10.1080/13510002.2017.1325572
8. 8. Hwang JH, Ryu J, An JN, et al. Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation. BMC Nephrol 2015;16:1-12. https://doi.org/10.1186/s12882-015-0108-3

9. 9. Toyokawa T, Kubo N, Tamura T, et al. The pretreatment Controlling Nutritional Status (CONUT) score is an independent prognostic factor in patients with resectable thoracic esophageal squamous cell carcinoma: results from a retrospective study. BMC Cancer 2016;16:1-4. https://doi.org/10.1186/s12885-016-2696-0
10. 10. Yoshihisa A, Kanno Y, Watanabe S, et al. Impact of nutritional indices on mortality in patients with heart failure. Open Heart 2018;5:1-8. https://doi.org/10.1136/openhrt-2017-000730
11. 11. De Ulíbarri JI, Gonzalez Madrono A, De Villar NGP, et al. CONUT : a tool for controlling nutritional status. Nutr Hosp 2005;20:38-45.
12. 12. Liu H, Yang XC, Liu DC, Tong C, Wen W, Chen RH. Clinical significance of the controlling nutritional status (CONUT) score in gastric cancer patients: a meta-analysis of 9,764 participants. Front Nutr 2023;10:1156006(e1-11). https://doi.org/10.3389/fnut.2023.1156006
13. 13. Di Vincenzo O, D'Elia L, Ballarin G, Pasanisi F, Scalfi L. Controlling Nutritional Status (CONUT) score and the risk of mortality or impaired physical function in stroke patients: a systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2023;33:1501-1510. https://doi.org/10.1016/j.numecd.2023.05.012
14. 14. Fukushima K, Ueno Y, Kawagishi N, et al. The nutritional index 'CONUT' is useful for predicting long-term prognosis of patients with end-stage liver diseases. Tohoku J Exp Med 2011;224:215-219. https://doi.org/10.1620/tjem.224.215
15. 15. Narumi T, Arimoto T, Funayama A, et al. Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol 2013;62:307-313. https://doi.org/10.1016/j.jjcc.2013.05.007
16. 16. Harimoto N, Yoshizumi T, Sakata K, et al. Prognostic significance of preoperative Controlling Nutritional Status (CONUT) score in patients undergoing hepatic resection for hepatocellular carcinoma. World J Surg 2017;41:2805-2812. https://doi.org/10.1007/s00268-017-4097-1
17. 17. Takagi K, Takahashi H, Miura T, et al. Prognostic value of the Controlling Nutritional Status (CONUT) score in patients at dialysis initiation. Nutrients 202231;14:2317(e1-11). https://doi.org/10.3390/nu14112317
18. 18. Huo Q, He T, Xiong J, Zhao J. Controlling nutritional status score is associated with renal progression, cardiovascular events, and all-cause mortality in biopsy-proved diabetic kidney disease. Front Physiol 2023;14:1231448(e1-10). https://doi.org/10.3389/fphys.2023.1231448
19. 19. Zhou H, Chao W, Cui L, Li M, Zou Y, Yang M. Controlling Nutritional Status (CONUT) score as immune-nutritional predictor of outcomes in patients undergoing peritoneal dialysis. Clin Nutr 2020;39:2564-2570. https://doi.org/10.1016/j.clnu.2019.11.018
20. 20. Zarifi SH, Shadnoush M, Pahlavani N, et al. Nutritional status in kidney transplant patients before and 6-month after transplantation: result of PNSI study. Clin Nutr ESPEN 2021;41:268-274. https://doi.org/10.1016/j.clnesp.2020.11.024