[Nutritional status of patients with functioning graft assessed by clinical examination, anthropometry and bioimpedance]. / Stan odzywienia pacjentów po przeszczepieniu nerki w badaniu klinicznym, antropometrycznym i bioimpedancji elektrycznej.

Malnutrition is very frequent comorbid factor in chronic renal failure and its prevalence both in the predialysis period as well as on maintenance dialysis is high. The aim of the study was to assess the nutritional status in patients after successful kidney transplantation. 109 patients (47 F, 67 M) of mean age 39.9 +/- 11.5 years were analyzed. Mean time after transplantation surgery was 32.2 +/- 37 months and the maintenance dialysis treatment period prior to transplantation--28.4 +/- 22 months. Nutritional status was assessed with clinical examination based on the SGA scale, anthropometric measurements as well as body composition estimation with bioimpedance. Daily food intake was also monitored with three-day dietary questionnaire. All above analyses were also performed in 25 healthy control subjects with corresponding sex and age distribution. No differences between all analyzed bioimpedance and anthropometry parameters were found between studied patients and controls. 79% of patients were classified as well nourished, 20%--as mildly or moderately malnourished and only 1%--as severely malnourished according to SGA scale. The BMI values less than 21 kg/m2, i.e. suggesting malnutrition were found in 23.3% of patients, whereas values above 25 kg/m2, i.e. suggesting overweight or obesity--in almost 40%. Interestingly, as high as 82.5% of studied patients were characterized by significant weight gain since last "dry weight" assessment on maintenance dialysis up to the time of study (by mean 9.42 +/- 6.9 kg). Obtained results permit us to conclude, that the prevalence of nutritional status abnormalities are relatively frequent among patients with functioning graft. Malnutrition can be demonstrated in more than 20% of the study population, which should be considered however to be markedly lower as compared to most reports regarding dialysis populations. Weight gain during posttransplant period as compared to maintenance dialysis is marked and common; thus the prevalence of obesity is also quite common and reaches 40% of tested patients.

[Renal osteodystrophy in dialysis patients as estimated by three-point bone densitometry]. / Osteodystrofia nerkowa u chorych dializowanych w ocenie trzypunktowego pomiaru densytometrycznego.

The aim of a study was to estimate the renal osteodystrophy status using bone densitometry in relation to selected biochemical parameters of calcium-phosphate metabolism. The study population consisted of 123 patients with end-stage renal disease, including 24 patients treated with continuous ambulatory peritoneal dialysis (CAPD), aged between 22 and 73 years (mean 49.9 years), on dialysis program for mean period of 14.9 months and 99 patients on maintenance hemodialysis for mean period of 58.8 months, aged between 19 and 72 years (mean 46.6 years). Densitometric measurements using DEXA technique were performed in three different skeletal points: distal ends of both radial bones, lumbar spinal region and femoral neck. Concomitantly, serum concentrations of total and ionized calcium, phosphates and parathormone as well as alkaline phosphatase serum activity were measured. Among male patients treated with CAPD significantly higher BMD values in right forearm were found as compared to women treated with this method (0.769 vs. 0.616; p < 0.001). Higher values of BMD were also found in both forearms in whole CAPD population as compared to those on hemodialysis. However, there was no difference in densitometry results between CAPD and HD patients as well as between men and women within these groups, when measured in femoral neck and lumbar spinal region. Among hemodialysis patients higher levels of phosphates and PTH were found as compared to CAPD, doses of drugs used for treatment of osteodystrophy--calcium carbonate, aluminum hydroxide and active vitamin D were also higher in individuals on HD. In addition, in CAPD patients statistically significant, positive correlations were found between BMD value in lumbar spinal area as well as in femoral neck and amount of ingested calcium carbonate, between BMD in lumbar spinal area and aluminum hydroxide dose taken by patients and between BMD in both forearms and dose of active vitamin D. We failed to demonstrate any relationship between obtained densitometric results as well as biochemical markers of calcium-phosphate metabolism and quantitative parameters of dialysis adequacy in both treatment modes. Obtained results let us to conclude that renal osteodystrophy is less advanced in patients treated with peritoneal dialysis, however this may be related only to markedly shorter renal replacement therapy period in this group. Lack of significant abnormalities in densitometry measurements taken in lumbar spinal area and femoral neck, while they are present in forearms, may suggest that the latter point of skeleton may be most useful for identification of bone mass deficiency in dialyzed patients.

[Usefulness of bioelectric impedance as a method for evaluating body composition of patients on peritoneal dialysis]. / Przydatnosc bioimpedancji jako metody oceny skladu ciala chorych dializowanych otrzewnowo.

The aim of a study was to evaluate the usefulness of bioelectric impedance as a method of body composition analysis in patients treated with CAPD, with the special attention paid on hydration status and lean body mass. The values of parameters obtained by bioelectric impedance and other methods were compared. The impact of peritoneal dialysis fluid in peritoneal cavity on bioimpedance measurement results were also analyzed. The study was performed in 33 patients dialyzed with CAPD for mean period of 12.3 months, aged between 23 and 72 years (mean 50.9 years). Bioimpedance measurements were also performed in 10 healthy volunteers. The significant impact of 2-liters dialysate volume on measurement results was found. The percentage water contain as well as LBM are under this condition higher (59.2% vs. 58.3%; p < 0.005 and 80.73 vs. 79.6; p < 0.01, respectively), and body fat--lower (19.07 vs. 20.39%; p < 0.005) as compared to empty peritoneal cavity. We also found, that the values of body water obtained from BEI measurements are higher as compared to those calculated from Watson formulas and lean body mass values obtained from BEI analysis are higher as compared to those derived from creatinine kinetics (39.4 vs. 36.96 I.; p < 0.05 and 53.7 vs. 51.1 kg; p < 0.01, respectively). Total and lean body mass did not differ from the values predicted in the treatment group, however the percentage contain of body water was significantly higher (58.34 vs. 51.39%; p < 0.0001). No significant differences were found between body composition of CAPD patients and control individuals.