FRAIL scale as a screening tool and a predictor of mortality in non-dialysis dependent patients.

BACKGROUND: This study aimed to compare the diagnostic yield of the FRAIL scale with respect to the physical frailty phenotype measure and their association with mortality in non-dialysis-dependent patients. METHODS: In this prospective cohort study, non-dialysis dependent patients with chronic kidney disease (CKD) stages 3b-5 seen in the nephrology outpatient clinics of two university hospitals were included. The presence of frailty was evaluated by physical frailty phenotype measure and the FRAIL scale. Patients were evaluated for six months, and mortality was recorded. The Kappa test was used to evaluate the diagnostic properties between the methods, and logistic regression to test the association between frailty and mortality. RESULTS: One hundred fifty-three patients were evaluated; average age was 65 (56-70) years, 50.9% were women, and the all-cause mortality rate was 2.6%. Forty-six patients were classified as living with frailty according to the physical frailty phenotype while 36 patients were rated frail by the FRAIL scale. In adults < 60 years of age, the FRAIL scale showed good accuracy (84.9%) and specificity (93.2%) but had low sensitivity (41.3%) and moderate agreement (Kappa = 0.41; p < 0.001) compared to the definition of the physical frailty phenotype. The adjusted logistic regression model showed that the patients with frailty assessed by the FRAIL scale had a greater chance of mortality than the non-frail patients (OR: 6.8; CI95%:1.477-31.513; p = 0.014). CONCLUSION: Physical frailty phenotype identifies more patients as having pre-frailty and frailty in non-dialysis dependent patients as compared to the FRAIL scale. However, the FRAIL scale is a simple bedside tool that can be useful for screening for frailty and whose results were associated with mortality.

Efeito de uma ação de aconselhamento nutricional, com uso de rede social, no enfrentamento à obesidade / Effect of a nutritional counseling activities, by using a social network, in coping with obesity

Estratégias inovadoras precisam ser adotadas para o combate à crescente prevalência de obesidade. Assim, o objetivo desse trabalho é avaliar o efeito de uma ação de aconselhamento nutricional com uso de rede social no enfrentamento à obesidade. Este é um estudo experimental do tipo antes e depois, incluindo 60 indivíduos com excesso de peso e adscritos a uma Unidade Básica de Saúde. Foi realizado de junho-outubro de 2020. As ações educativas (compartilhamento de informações sobre alimentação saudável e saúde e pactuação de desafios) foram realizadas pelo aplicativo WhatsApp®, semanalmente, por 16 semanas. Foram coletadas informações sociodemográficas, econômicas, clínicas, antropométricas, sobre consumo alimentar e exames bioquímicos. Os dados foram comparados por teste de Wilcoxon ou Kappa. A maioria dos participantes era do sexo feminino e 36,4% com diagnóstico de hipertensão. Após a intervenção, verificou-se redução de circunferência da cintura (antes:107,3±11,4; depois:105,6±11,5 cm, p=0,004), colesterol total (antes:205,9±48,3; depois:191,5±34,3 mg/dL, p<0,001) e LDL-c (antes:132,4±37,8; depois:120,2±29,3 mg/dL, p<0,001). A ação foi capaz de promover reduções de marcadores corporais de obesidade e de descompensações metabólicas associadas a obesidade, demonstrando a importância de intervenções inovadoras que possam somar a outras intervenções e facilitar a adesão do público.

Innovative strategies need to be adopted to combat the growing prevalence of obesity. Thus, the aim of this study is to evaluate the effect of a nutritional counseling activity using a social network in coping with obesity. This is a before-and-after experimental study, including 60 overweight individuals enrolled in a Primary Care Center. It was carried out from June to October 2020. Educational actions (sharing information about healthy eating and health and agreeing on challenges) were carried out through the WhatsApp® application, weekly, for 16 weeks. Sociodemographic, economic, clinical, anthropometric, food consumption, and biochemical data were collected. Data were compared by the Wilcoxon or Kappa test. Most participants were female and 36.4% had a diagnosis of hypertension. After the intervention, there was a reduction in waist circumference (before:107.3±11.4; after:105.6±11.5 cm, p=0.004), total cholesterol (before:205.9±48, 3; after:191.5±34.3 mg/dL, p<0.001), and LDL-c (before:132.4±37.8; after:120.2±29.3 mg/dL, p<0.001). The activity was able to promote reductions in body markers of obesity and metabolic imbalances associated with obesity, demonstrating the importance of innovative interventions that can add to other interventions and facilitate public adherence.

Antioxidant and anti-inflammatory response to curcumin supplementation in hemodialysis patients: A randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND AND OBJECTIVES: Hemodialysis (HD) patients are vulnerable to malnutrition and cardiovascular complications due to many factors, including oxidative stress and inflammation. Curcumin supplementation is associated with attenuation of proinflammatory cytokines and increased activity of antioxidant enzymes, but its effects in HD patients are unknown. This study aimed to evaluate the effect of curcumin supplementation on oxidative stress and inflammation in HD patients. METHODS: This randomized, double-blind, placebo-controlled trial enrolled 43 HD patients and divided them into two groups: supplemented with curcumin (1 g/day) or placebo (corn starch) for 12 weeks. Demographic information and blood samples were taken at the start and the end of the study to determine serum malondialdehyde (MDA) concentrations, antioxidant enzyme activity, and high-sensitivity C-reactive protein (hs-CRP). RESULTS: The curcumin group showed a significant increase in catalase activity [Δ = 1.13 ± 2.87 versus Δ = -1.08 ± 2.68; p = 0.048] and preserved glutathione peroxidase activity [Δ = -4.23 ± 11.50 versus Δ = -14.44 ± 13.96; p < 0.01] compared with the placebo group. However, no significant changes were found in MDA concentrations, glutathione reductase activity, and hs-CRP concentrations after the intervention. CONCLUSION: Curcumin supplementation for 12 weeks had potential effects on antioxidant response, but it was not enough to reduce oxidative stress markers and inflammation in HD patients. This trial was registered at EnsaiosClínicos.gov.br under registration number RBR-2t5zpd.

Músculo adutor do polegar e força de preensão palmar: métodos potenciais de avaliação nutricional em pacientes cirúrgicos / Adductor pollicis muscle and handgrip strength: potential methods of nutritional assessment in surgical patients

Medidas da espessura do músculo adutor do polegar (EMAP) e da força de preensão palmar (FPP) são de fácil e rápida aplicação, baixo custo e poderão detectar alterações do estado nutricional em curto prazo. A utilização dessas medidas agilizaria o diagnóstico nutricional e otimizaria a atenção aos pacientes hospitalizados. O objetivo deste estudo foi avaliar a associação entre EMAP e FPP com parâmetros antropométricos, avaliação subjetiva global (ASG) e marcadores bioquímicos de pacientes admitidos para a realização de cirurgia do aparelho digestivo e órgãos anexos. Trata-se de um estudo transversal em que foram avaliadas o índice de massa corporal (IMC), circunferência braquial (CB), dobra cutânea tricipital, circunferência muscular do braço, EMAP, FPP, ASG e variáveis bioquímicas. Participaram 56 pacientes, sendo evidenciado que o aumento de uma unidade na CB promoveu um aumento de 0,73 kgf na FPP (IC95%: 0,30;1,17, p=0,002). O aumento de uma unidade no peso habitual, CB e albumina sérica ajustado pela altura, idade e sexo foi associado a maiores valores da EMAP (peso habitual: 0,92 mm; IC95%: 0,18;1,66, p=0,017; CB: 0,69 mm; IC95%: 0,27;1,11, p=0,006; albumina sérica 1,83 mm; IC95% 0,10; 3,57, p=0,039). Por outro lado, o aumento de uma unidade da perda de peso (%) e IMC refletiu em redução de 0,85 mm (IC95%: -1,46; -0,25, p=0,008) e 2,80 mm da EMAP (IC95%: -4,73; -0,88, p=0,006), respectivamente. Há associação positiva entre FPP e CB e entre EMAP, peso habitual, CB e albumina sérica e associação inversa entre EMAP, IMC e percentual de perda de peso.

Measurements of the adductor pollicis muscle thickness (APMT) and handgrip strength (HGS) are easy and quick to apply, low cost, and may detect changes in nutritional status in the short term. The use of these measurements would speed up the nutritional diagnosis and optimize the care of hospitalized patients. The aim of this study was to evaluate the association between APMT and HGS with anthropometric parameters, subjective global assessment (SGA), and biochemical markers in patients admitted for digestive tract and adnexal organ surgery. This is a cross-sectional study in which body mass index (BMI), arm circumference (AC), triceps skinfold thickness, arm muscle circumference, APMT, HGS, SGA and biochemical variables were evaluated. A total of 56 patients participated, showing that the increase of one unit in the AC promoted an increase of 0.73 kgf in the HGS (95%CI: 0.30;1.17, p=0.002). A one-unit increase in normal weight, AC, and serum albumin adjusted for height, age, and gender was associated with higher APMT values (normal weight: 0.92 mm, 95%CI: 0.18;1.66, p=0.017; AC: 0.69 mm, 95%CI: 0.27;1.11, p=0.006; serum albumin 1.83 mm, 95%CI: 0.10;3.57, p=0.039). On the other hand, the increase of one unit in weight loss (%) and BMI resulted in a reduction of 0.85 mm (95%CI: -1.46;-0.25, p=0.008) and 2.80 mm in the APMT (95%CI: -4.73;-0.88, p=0.006), respectively. There is a positive association between HGS and AC and between APMT, normal weight, AC, and serum albumin, and an inverse association between APMT, BMI, and percentage of weight loss.

Serious Game on a Smartphone for Adolescents Undergoing Hemodialysis: Development and Evaluation.

BACKGROUND: Adolescents with chronic kidney disease have a hard time adhering to hemodialysis as a therapy, indicating a need to establish new alternatives for motivation and adherence to treatment. OBJECTIVE: The objective of this study was to develop and evaluate a serious game to stimulate and motivate adolescents undergoing hemodialysis. METHODS: We describe the technological production followed by a qualitative analysis. We invited 8 adolescents undergoing hemodialysis in the city Goiânia, located in the midwest of Brazil, to participate. The final convenience sample included 7 (87.5% of the target population) adolescents. The process was conducted in 3 phases: creation of a serious game, evaluation of its use, and observation of its motivating effect on behavioral modification with a focus on acquiring the necessary competence for self-care. RESULTS: An app (Bim) in the modality of a serious game was developed to be used during hemodialysis; the player was encouraged to take care of a character with daily actions during his or her treatment. The game was made available to adolescents aged 10-14 years. Mobile devices were offered during the hemodialysis treatment for a period of 30-40 minutes, 3 times a week for 60 days. The usage definitions of the game were freely chosen by the participants. The qualitative evaluation of the use of the Bim app showed that it encompasses scenarios and activities that enable the exercise of daily actions for the treatment of patients. The behavioral evaluation showed that the Bim app worked as a motivating stimulus for behavioral adherence to hemodialysis requirements. CONCLUSIONS: The easy-to-access app interface showed good operability for its users. The description of the character and proposed activities contributed to motivation and ability to cope with hemodialysis care.

Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis / Adaptação transcultural do instrumento Thirst Distress Scale (TDS) para o português brasileiro e propriedades psicométricas em pacientes em hemodiálise

Abstract Objective: To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD). Methods: The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). Results: The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). Conclusion: Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.

Resumo Objetivo: Realizar a adaptação transcultural da escala Thirst Distress Scale (TDS) para o português brasileiro e estudar suas propriedades psicométricas em pacientes em hemodiálise (HD). Métodos: Foram realizadas traduções, retrotraduções, discussão com especialistas e avaliação psicométrica, com aplicação da versão final em 126 pacientes em HD e reteste em 70 pacientes da amostra inicial. A consistência interna do instrumento foi obtida pelo alfa de Cronbach. Para analisar a concordância com a intensidade de sede, avaliada pela Escala Visual Analógica (EVA), foi utilizado o teste Kappa e a estratégia gráfica de Bland-Altman. Para avaliar a reprodutibilidade, foi realizado teste de correlação intraclasse (CCI). Resultados: Para obtenção da versão final da escala TDS em português brasileiro, intitulada TDS-BR, foi necessária adaptação de vocabulário em três itens e mudança de tempo verbal em seis itens. Houve boa compreensão da escala pelos pacientes em HD, consistência interna satisfatória (0,84, p<0,001), concordância moderada com a Escala Visual Analógica (EVA) (kappa=0,44; p<0,001) e reprodutibilidade quase perfeita (CCI=0,87; p<0,001). Conclusão: Os resultados obtidos indicam a aplicabilidade e confiabilidade do instrumento na língua portuguesa (Brasil). A ferramenta, por ser de fácil compreensão e baixo custo, além de ter boa aceitação, pode ser um instrumento relevante no manejo da sede de pacientes em HD.

Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis.

OBJECTIVE: To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD). METHODS: The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). RESULTS: The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). CONCLUSION: Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.

Intradialytic Resistance Training Improves Functional Capacity and Lean Mass Gain in Individuals on Hemodialysis: A Randomized Pilot Trial.

OBJECTIVE: To compare the effects of high vs moderate loads of intradialytic resistance training (RT) on body composition, sarcopenia prevalence, functional capacity, inflammatory markers, and quality of life (QoL) in individuals on hemodialysis. DESIGN: A pilot randomized clinical trial. SETTING: Two hemodialysis centers. PARTICIPANTS: Individuals on hemodialysis (N=80; 51% men, aged 30-75y) in treatment for at least 3 months, adequately dialyzed (Kt/V≥1.2, where K is dialyzer clearance in mL/min, t is time, and V is volume of water) with vascular access via arteriovenous fistula. INTERVENTIONS: The 12 weeks of intradialytic RT was performed 3 times per week. The training groups were: high-load intradialytic group (HLG, 8-10 repetitions), moderate-load intradialytic group (MLG, 16-18 repetitions), and control group (CG, stretching exercise). The total training volume was equalized among training groups. MAIN OUTCOME MEASURES: Lean leg mass was assessed by a dual-energy x-ray absorptiometry; functional capacity was assessed by Short Physical Performance Battery and Timed Up and Go test; and QoL was assessed by Kidney Disease QoL Instrument, inflammatory markers, and sarcopenia. RESULTS: After the training period, the HLG increased lean leg mass compared with the CG. The HLG also displayed improvements in the pain and physical function domains. The skeletal muscle index and functional capacity increased in both RT protocols. The prevalence of sarcopenia was reduced 14.3% and 25% in the MLG and HLG, respectively, while there was an increase of 10% in the CG. No differences were observed in cytokines after intervention. CONCLUSIONS: High-load intradialytic RT was associated with gains in lean leg mass and QoL while functional capacity, appendicular muscle mass, and sarcopenia status were improved regardless of the RT load.

Aplicativos como estratégia de ensino na doença renal crônica infantil: uma revisão da literatura / APPS as strategy of teaching for child with chronic kidney disease: a review of literature

OBJETIVOS: realizar um levantamento sobre o desenvolvimento de aplicativos voltados para o paciente renal crônico infantil no Brasil e propiciar uma reflexão sobre sua contribuição no âmbito do autocuidado. MÉTODO: Utilizou se revisão da literatura, com consulta às bases de dados LILACS, MEDLINE e SCIELO entre janeiro e abril de 2016.Foram identificados 73 artigos e selecionados 14 para o estudo. RESULTADOS: Não foram encontradas publicações abordando dispositivos voltados para pacientes renais, porém os estudos escolhidos discutem o potencial dos aplicativos para promoção da saúde através do repasse de informações, melhoria na comunicação, estímulo à autonomia e inclusão social. CONCLUSÃO: A utilização dessa tecnologia na saúde surge como estratégia de ensino-aprendizado, sendo factível como ferramenta para a criança portadora de doença renal. Dessa forma, propõe-se validar o BIM, aplicativo com vistas à educação para percepção de saúde, autocuidado e melhoria na qualidade de vida dessa população.

OBJECTIVES: to conduct a survey on the development of applications facing child chronic renal patients in Brazil and provide a reflection on their contribution in the self-care. METHOD: We used literature review, in consultation with the databases LILACS, MEDLINE and SCIELO between January and April 2016. We identified 73 articles and 14 selected for the study. RESULTS: Publications addressing facing devices for renal patients were not found, but studies chosen discuss the potential of health promotion for applications through the transfer of information, improved communication, stimulating autonomy and social inclusion. CONCLUSION: The use of this technology in health emerges as a teaching and learning strategy is feasible as a tool for child with kidney disease. Thus, it is It proposes to validate BIM app with a view to education for perceived health, self-care and improve the quality of life of this population.

Nutritional status and interdialytic weight gain of chronic hemodialysis patients.

INTRODUCTION: The nutritional status (NS) of patients on hemodialysis (HD) is a major concern and challenge. Malnutrition is common in these patients and is related to poorer clinical outcomes. OBJECTIVES: To assess the association between the NS and the interdialytic weight gain (IDWG) of patients with chronic kidney disease (CKD) on HD. METHODS: Cross-sectional study with 322 patients older than 18 years. The NS was assessed by body mass index (BMI), percentage body fat estimated by the sum of four skinfolds (triceps, biceps, subscapular and supra iliac), lean body mass (LBM), serum creatinine and albumin and rate of nitrogen appearance (PNA). The IDWG was evaluated from the sum of the weight difference of 12 hemodialysis sessions (IDWGm). RESULTS: Considering the sample into quartiles IDWGm, it was found that BMI, LBM, serum creatinine ( p < 0.001) and PNA ( p = 0.011) were directly correlated. There was no association between IDWGm and serum albumin. Using multivariate analysis, it was found that the prevalence of patients with BMI suitability and serum creatinine were significantly higher for patients in the bottom quartile with respect to the first IDWGm. CONCLUSION: The NS is positively associated with IDWG. The results point to the need for individualized assessment of IDWG and cautious in order not to generalize a recommendation that does not meet the expectations of maintaining and promoting the nutritional status of these patients.

Is energy intake underreported in hemodialysis patients?

INTRODUCTION: Underreporting of energy intake is not much studied in hemodialysis population. OBJECTIVE: To evaluate the underreporting of energy intake and associated factors in hemodialysis patients. METHODS: A cross-sectional study, with 344 patients stable adults, of ten hemodialysis centers in Goiânia-GO. Energy intake was assessed by six 24-hour dietary recalls and basal metabolic rate (BMR) was estimated using the Harris Benedict equation. It was considered as underreporting when the ratio between the average energy intake and basal metabolic rate was lower than1.27. For analysis of factors associated with underreporting, the Poisson regression with robust variance estimation was applied. RESULTS: The prevalence of underreporting was 65.7%, being more significant in individuals who are overweight and in the non dialysis days. The result of the multivariate analysis identified four factors independently associated with the underreporting: being a female (PR = 1.27, CI = 1.10 to 1.46), body mass index ≥ 25 kg/m2 (PR = 1.29, CI = 1.12 to 1.48), three meals or lower/day (PR = 1.31, CI = 1.14 to 1.51) and hemodialysis length lower than 5 years (PR = 1.19CI = 1.01 to 1.40). CONCLUSION: The population showed a high prevalence of underreporting of energy intake. Being a female, presenting overweight, lower number of meals/day and lower length time on hemodialysis were factors associated with underreporting.

A ingestão energética de pacientes em hemodiálise é subrelatada? / Is energy intake underreported in hemodialysis patients?

ResumoIntrodução:O sub-relato da ingestão energética é pouco estudado na população em hemodiálise.Objetivo:Avaliar o sub-relato da ingestão energética e os fatores associados em pacientes em hemodiálise.Métodos:Estudo transversal, com 344 pacientes adultos estáveis, de dez centros de hemodiálise de Goiânia-GO. A ingestão energética foi avaliada por seis recordatórios de 24 horas e a taxa de metabolismo basal (TMB) foi calculada pela equação de Harris Benedict. Foi considerado como sub-relato quando a razão entre a ingestão energética média e a TMB foi menor que 1,27. Para análise dos fatores associados ao sub-relato, foi utilizada a regressão de Poisson com estimativa robusta da variância.Resultados:A prevalência de sub-relato foi de 65,7%, sendo mais expressiva em indivíduos com excesso de peso e nos dias sem diálise. O resultado final da análise multivariada identificou quatro fatores independentemente associados ao sub-relato: sexo feminino (RP = 1,27; IC = 1,10-1,46), índice de massa corporal ≥ 25 kg/m2 (RP = 1,29; IC = 1,12-1,48), três ou menos refeições/dia (RP = 1,31; IC = 1,14-1,51) e tempo de hemodiálise inferior a cinco anos (RP = 1,19; IC = 1,01-1,40).Conclusão:A população avaliada demonstrou elevada prevalência de sub-relato da ingestão energética. Pertencer ao sexo feminino, apresentar excesso de peso, fazer um menor número de refeições diárias e ter menos tempo de hemodiálise foram fatores associados ao sub-relato.

AbstractIntroduction:Underreporting of energy intake is not much studied in hemodialysis population.Objective:To evaluate the underreporting of energy intake and associated factors in hemodialysis patients.Methods:A cross-sectional study, with 344 patients stable adults, of ten hemodialysis centers in Goiânia-GO. Energy intake was assessed by six 24-hour dietary recalls and basal metabolic rate (BMR) was estimated using the Harris Benedict equation. It was considered as underreporting when the ratio between the average energy intake and basal metabolic rate was lower than1.27. For analysis of factors associated with underreporting, the Poisson regression with robust variance estimation was applied.Results:The prevalence of underreporting was 65.7%, being more significant in individuals who are overweight and in the non dialysis days. The result of the multivariate analysis identified four factors independently associated with the underreporting: being a female (PR = 1.27, CI = 1.10 to 1.46), body mass index ≥ 25 kg/m2 (PR = 1.29, CI = 1.12 to 1.48), three meals or lower/day (PR = 1.31, CI = 1.14 to 1.51) and hemodialysis length lower than 5 years (PR = 1.19CI = 1.01 to 1.40).Conclusion:The population showed a high prevalence of underreporting of energy intake. Being a female, presenting overweight, lower number of meals/day and lower length time on hemodialysis were factors associated with underreporting.

Estado nutricional e ganho de peso interdialítico de pacientes com doença renal crônica em hemodiálise / Nutritional status and interdialytic weight gain of chronic hemodialysis patients

ResumoIntrodução:O estado nutricional (EN) de pacientes em hemodiálise (HD) é motivo de preocupação e de desafio. A desnutrição é comum nestes pacientes e relaciona-se com pior prognóstico clínico.Objetivos:Avaliar a associação entre o EN e o ganho de peso interdialítico (GPID) de pacientes com doença renal crônica (DRC) em hemodiálise (HD).Métodos:Estudo transversal realizado com 322 pacientes maiores de 18 anos. O EN foi avaliado por meio do índice de massa corporal (IMC), percentual de gordura corporal estimado pela somatória de quatro dobras cutâneas (tricipital, bicipital, suprailíaca e subescapular), massa corporal magra (MCM), creatinina e albumina sérica e a taxa de aparecimento do nitrogênio (PNA). O GPID foi avaliado a partir da somatória da diferença de peso de 12 sessões de hemodiálise (GPIDm).Resultados:Considerando-se a amostra em quartis de GPIDm, verificou-se que o IMC, MCM, creatinina sérica (p < 0,001) e PNA (p = 0,011) estavam diretamente correlacionados. Não foi verificada associação entre o GPIDm e os níveis de albumina sérica. Por meio de análise multivariada, verificou-se que a prevalência de pacientes com adequação ao IMC e a creatinina sérica foi significativamente maior para pacientes do último quartil de GPIDm em relação ao primeiro.Conclusão:O EN associou-se positivamente ao GPID. Os resultados apontam para necessidade de avaliação individualizada e cautelosa do GPID, a fim de não se generalizar uma recomendação que não satisfaça as expectativas de manutenção e promoção do estado nutricional desses pacientes.

AbstractIntroduction:The nutritional status (NS) of patients on hemodialysis (HD) is a major concern and challenge. Malnutrition is common in these patients and is related to poorer clinical outcomes.Objectives:To assess the association between the NS and the interdialytic weight gain (IDWG) of patients with chronic kidney disease (CKD) on HD.Methods:Cross-sectional study with 322 patients older than 18 years. The NS was assessed by body mass index (BMI), percentage body fat estimated by the sum of four skinfolds (triceps, biceps, subscapular and supra iliac), lean body mass (LBM), serum creatinine and albumin and rate of nitrogen appearance (PNA). The IDWG was evaluated from the sum of the weight difference of 12 hemodialysis sessions (IDWGm).Results:Considering the sample into quartiles IDWGm, it was found that BMI, LBM, serum creatinine ( p < 0.001) and PNA ( p = 0.011) were directly correlated. There was no association between IDWGm and serum albumin. Using multivariate analysis, it was found that the prevalence of patients with BMI suitability and serum creatinine were significantly higher for patients in the bottom quartile with respect to the first IDWGm.Conclusion:The NS is positively associated with IDWG. The results point to the need for individualized assessment of IDWG and cautious in order not to generalize a recommendation that does not meet the expectations of maintaining and promoting the nutritional status of these patients.

Food intake in patients on hemodialysis / Ingestão alimentar de pacientes em hemodiálise

Objective: To evaluate the intake of energy and nutrients by individuals on hemodialysis, following especific recommendations for this population and according to Food Guide for the Brazilian Population. Methods: A cross-sectional study, 118 adult patients, considered stable from, ten dialysis centers in Goiânia, Goiás. Dietary intake was estimated by six 24-hour recalls, and classified as adequate or inadequate, according to specific recommendations for individuals undergoing dialysis and that recommended for a healthy diet. A descriptive analysis was performed. Results: Average dietary intake of 2022.40 ± 283.70 kcal/day; 31.18 kcal/kg/day; 55.03 ± 4.20% carbohydrate; 30.23 ± 3.71% lipid, 1.18 ± 0.23 g protein/kg/day. Important prevalences of inadequacy were observed for the intake of calories (39.0%), protein (39.0%) and other nutrients such as retinol (94.9%), saturated fat (87.3%), cholesterol (61,9%), iron (61.0%), potassium (60.2%) and zinc (45.0%). Patients had a low intake of fruit food group (1.22 ± 0.89 servings) and vegetables (1.76 ± 1.01 servings), dairy products (0.57 ± 0.43 servings) and high intake of food group of oils and fats (3.45 ± 0.95 servings), sugars and sweets (1.55 ± 0.77 servings). Conclusion: Observed food consumption imbalance, characterized by excess of oils and fats, especially saturated oils and cholesterol, sugars and sweets, parallel to low intake of fruits and vegetables and dairy products. A considerable percentage of patients did not intake the minimum recommended of calories, protein, retinol, iron, zinc and potassium. .

Objetivo: Avaliar o consumo de energia e nutrientes de indivíduos em hemodiálise, segundo recomendações específicas para essa população, e de acordo com o Guia Alimentar para a População Brasileira. Métodos: Trata-se de estudo transversal, com 118 pacientes adultos considerados estáveis, tratados em 10 centros de diálise em Goiânia, Estado de Goiás. A ingestão alimentar foi estimada por meio de seis recordatórios de 24 horas, sendo classificada em adequada ou inadequada, conforme recomendações específicas para indivíduos em hemodiálise, é recomendado para uma alimentação saudável. Foi realizada análise descritiva dos dados. Resultados: Observou-se ingestão alimentar média de 2022,40 ± 283,70 kcal/dia; 31,18 kcal/kg/dia; 55,03 ± 4,20% de carboidrato; 30,23 ± 3,71% de lipídeo; e 1,18 ± 0,23 g de proteína/kg/dia. Importantes prevalências de inadequação foram observadas para a ingestão de calorias (39,0%), proteínas (39,0%) e outros nutrientes, como retinol (94,9%), gordura saturada (87,3%), colesterol (61,9%), ferro (61,0%), potássio (60,2%) e zinco (45,0%). Os pacientes apresentaram baixa ingestão de alimentos do grupo das frutas (1,22 ± 0,89 porções), legumes e verduras (1,76 ± 1,01 porções), leite e derivados (0,57 ± 0,43 porções), bem como ingestão elevada de alimentos do grupo dos óleos e gorduras (3,45 ± 0,95 porções) e açúcares e doces (1,55 ± 0,77 porções). Conclusão: Foi observado um consumo alimentar em desequilíbrio, caracterizado ...

Nutritional assessment and hand grip strength of candidates for surgery of the gastrointestinal tract / Avaliação nutricional e força de aperto de mão de candidatos à cirurgia do trato gastrointestinal

BACKGROUND: The assessment of nutritional status in clinical practice must be done with simple, reliable, low cost and easy performance methods. The power of handshake is recognized as a useful tool to evaluate muscle strength, and therefore, it is suggested that can detect malnutrition. AIM: To evaluate the nutritional status by subjective global assessment and power of handshake preoperatively in patients going to gastrointestinal surgeries and to compare the diagnosis obtained by subjective global assessment with traditional anthropometric methods and power of handshake. METHODS: A cross-sectional study was conducted with patients for surgery in the gastrointestinal tract and related organs. Socioeconomic and anthropometric data, applied to subjective global assessment and checked the power of handshake, were collected. The force was obtained by the average of three measurements of the dominant and non-dominant hand and thus compared with reference values ​​of the population by sex and age, for the classification of nutritional risk. RESULTS: The sample consisted of 40 patients, 24-83 years, and most women (52.5%) housewives (37,5%) and diagnosed with cancer (45%). According to subjective global assessment, 37.5% were classified as moderately malnourished; 15% were underweight by BMI measurements; 25% had arm circumference at risk for malnutrition (<percentil 5); 60% reported recent weight loss; and 37.5% low clamping force in power of handshake on non-dominant hand (left). CONCLUSION: A significant association was observed for the diagnosis of nutritional subjective assessment with anthropometric methods and strength of the handshake only at the non-dominant limb. .

RACIONAL: Na prática clínica são necessários métodos simples, confiáveis, de baixo custo e de fácil acesso para a avaliação do estado nutricional. A força do aperto de mão é reconhecida como uma ferramenta útil para avaliar a força muscular, e consequentemente, elemento que pode detectar desnutrição. OBJETIVO: Avaliar o estado nutricional tanto pela avaliação nutricional subjetiva global como pela força do aperto de mão de pacientes em pré-operatório e comparar o diagnóstico obtido por ambas e os tradicionais métodos antropométricos. MÉTODOS: Foi realizado estudo transversal com pacientes internados para operação em trato gastrointestinal e órgãos anexos. Foram coletados dados socioeconômicos, antropométricos, aplicado a avaliação nutricional subjetiva global e verificada a força do aperto de mão. Esta força foi obtida pela média de três medidas da mão dominante e não dominante e dessa forma, comparada com valores de referência da população brasileira, segundo sexo e idade, para a classificação do risco nutricional. RESULTADOS: A amostra foi constituída por 40 pacientes de 24 a 83 anos, a maioria mulheres (52,5%) donas de casa (37,5%) e com diagnóstico de neoplasia (45%). Segundo a avaliação nutricional subjetiva global, 37,5% foram classificados como desnutridos moderados; 15% com baixo peso pelo IMC; 25% com circunferência braquial em risco para desnutrição (<percentil 5); 60% com perda ponderal recente; e pela força do aperto de mão, 37,5% tinham baixa força na mão não dominante (esquerda). CONCLUSÃO: Houve associação significativa do diagnóstico nutricional observado pela avaliação subjetiva com ...

Nutritional assessment and hand grip strength of candidates for surgery of the gastrointestinal tract.

BACKGROUND: The assessment of nutritional status in clinical practice must be done with simple, reliable, low cost and easy performance methods. The power of handshake is recognized as a useful tool to evaluate muscle strength, and therefore, it is suggested that can detect malnutrition. AIM: To evaluate the nutritional status by subjective global assessment and power of handshake preoperatively in patients going to gastrointestinal surgeries and to compare the diagnosis obtained by subjective global assessment with traditional anthropometric methods and power of handshake. METHODS: A cross-sectional study was conducted with patients for surgery in the gastrointestinal tract and related organs. Socioeconomic and anthropometric data, applied to subjective global assessment and checked the power of handshake, were collected. The force was obtained by the average of three measurements of the dominant and non-dominant hand and thus compared with reference values of the population by sex and age, for the classification of nutritional risk. RESULTS: The sample consisted of 40 patients, 24-83 years, and most women (52.5%) housewives (37,5%) and diagnosed with cancer (45%). According to subjective global assessment, 37.5% were classified as moderately malnourished; 15% were underweight by BMI measurements; 25% had arm circumference at risk for malnutrition (

Prevalence of malnutrition and associated factors in hemodialysis patients / Prevalência de desnutrição e fatores associados em pacientes em hemodiálise

OBJECTIVE: To assess the prevalence of malnutrition and associated factors in hemodialysis patients. METHODS: This is a cross-sectional study of 344 hemodialysis patients from Goiânia, Goiás aged 18 years or more. The dependent variable, malnutrition, was investigated by the Subjective Global Assessment. The independent variables included socioeconomic, demographic, and lifestyle data, clinical history, and energy and protein intakes. The patients underwent anthropometric measurements and laboratory tests. Multiple Poisson regression determined the associated factors (p<0.05). RESULTS: Mild or moderate malnutrition was found in 22.4% of the patients. Malnourished patients had lower body mass index, mid-arm muscle circumference, percentage of body fat, serum creatinine (p<0.001), and normalized protein nitrogen appearance (p=0.001). Multivariate analysis identified the following factors associated with malnutrition: age between 19 and 29 years (PR=1.23, 95%CI=1.06-1.43), family income less than 2 minimum salaries (PR=1.13, 95%CI=1.01-1.27), hemodialysis vintage >60 months (PR=1.08, 95%CI=1.01-1.16), Kt/V>1.2 (RP=1.12, 95%CI=1.03-1.22), calorie intake <35 kcal/kg/day (PR=1.22, 95%CI=1.10-1.34), and normalized protein nitrogen appearance <1.0 g/kg/day (PR=1.13, 95%CI=1.05-1.21). CONCLUSION: The prevalence of malnutrition in this population was high, corroborating the literature. The prevalence was higher in patients aged less than 29 years and those with low family income, longer hemodialysis vintage, higher Kt/V, and inadequate protein and calorie intakes. Strategies to reverse this situation should include more nutritional care. .

OBJETIVO: Avaliar a prevalência e os fatores associados à desnutrição em pacientes em hemodiálise. MÉTODOS: Estudo transversal com 344 pacientes maiores de 18 anos em hemodiálise em Goiânia, Goiás. A variável dependente, desnutrição, foi obtida por meio da avaliação subjetiva global. As variáveis independentes envolveram aspectos socioeconômicos, demográficos, estilo de vida, história clínica, ingestão energética e proteica. Realizaram-se antropometria e exames laboratoriais. A análise dos fatores associados foi realizada por regressão de Poisson múltipla (p<0,05). RESULTADOS: A prevalência de desnutrição leve ou moderada foi constatada em 22,4% dos pacientes. Os pacientes desnutridos apresentaram menor índice de massa corporal, menor circunferência muscular do braço, menor porcentagem de gordura corporal, menor valor de creatinina sérica (p<0,001) e nPNA (p=0,001).O resultado final da análi-se multivariada identificou os fatores associados à desnutrição: idade de 19 a 29 anos (RP=1,23; IC95%=1,06-1,43), renda familiar <2 salários-mínimos (RP=1,13; IC95%=1,01-1,27), tempo em HD >60 meses (RP=1,08; IC95%=1,01-1,16), Kt/V >1,2 (RP=1,12; IC95%=1,03-1,22), ingestão calórica inferior a 35 kcal/kg/dia (RP=1,22; IC95%=1,10-1,34) e nPNA <1,0 g/kg/dia (RP=1,13; IC95%=1,05-1,21). CONCLUSÃO: Observou-se alta prevalência de desnutrição na população estudada em acordo com o encontrado na literatura. A prevalência foi maior entre os pacientes com idade inferior a 29 anos, renda familiar baixa, maior tempo em hemodiálise, maior Kt/V e ingestão calórica e proteica inadequadas. Estratégias para reverter esta situação devem envolver maior atenção nutricional. .

Prevalência e fatores associados à obesidade abdominal em pacientes em hemodiálise em Goiânia - GO / Prevalence and associated factors with abdominal obesity in hemodialysis patients in Goiânia - GO

INTRODUÇÃO: A presença de excesso de peso, especialmente obesidade visceral, contribui para o maior risco de complicações metabólicas e cardiovasculares em pacientes com doença renal crônica. OBJETIVO: Determinar a prevalência e os fatores associados à obesidade abdominal em pacientes em hemodiálise (HD). MÉTODOS: Estudo transversal com 344 pacientes maiores de 18 anos. A obesidade abdominal foi definida pela circunferência da cintura > 94 cm nos homens e > 80 cm nas mulheres. As variáveis independentes envolveram aspectos socioeconômicos, demográficos, hábitos de vida, tempo em HD, consumo alimentar e índice de massa corporal (IMC). A análise dos fatores associados foi realizada por regressão de Poisson múltipla, permanecendo no modelo final as variáveis com p < 0,05. RESULTADOS: A prevalência de obesidade abdominal foi de 44,77%, sendo mais prevalente nas mulheres (55,71%) que nos homens (37,25%), p = 0,001. O resultado final da análise multivariada identificou os fatores associados à obesidade abdominal em homens e mulheres: idade superior a 40 anos, ingestão proteica inferior a 1,2 g/kg/dia e IMC > 25 kg/m². Nos homens, a classe econômica D/E também permaneceu associada à obesidade abdominal, p < 0,05. CONCLUSÃO: Observou-se alta prevalência de obesidade abdominal em pacientes em hemodiálise. Idade superior a 40 anos, classes econômicas mais baixas, ingestão proteica inferior ao recomendado e excesso de peso foram associados à obesidade abdominal.

INTRODUCTION: The presence of excess weight, especially visceral obesity contributes to the increased risk of metabolic and cardiovascular complications in patients with chronic kidney disease. OBJECTIVE: To determine the prevalence and associated factors with abdominal obesity in patients on hemodialysis (HD). METHODS: Cross-sectional study with 344 patients older than 18 years. Abdominal obesity was defined as waist circunference > 94 cm in men and > 80 cm in women. The independent variables involved socioeconomic, demographic, lifestyle, duration of HD, food consumption and body mass index (BMI). The analysis of associated factors was performed by multiple Poisson regression, remaining in the final model variables with p < 0.05. RESULTS: The prevalence of abdominal obesity was 44.77% and was more prevalent in women (55.71%) than in men (37.25%), p = 0.001. The end result of the multivariate analysis identified factors associated with abdominal obesity in men and women: age over 40 years, protein intake below 1.2 g/kg/day and BMI > 25 kg/m². In men the economic class D/E remained associated with abdominal obesity, p < 0.05. CONCLUSION: There was a high prevalence of abdominal obesity in hemodialysis patients. Age greater than 40 years, lower socioeconomic classes, below the recommended protein intake and overweight were associated with abdominal obesity.

Prevalence and associated factors with abdominal obesity in hemodialysis patients in Goiânia--GO.

INTRODUCTION: The presence of excess weight, especially visceral obesity contributes to the increased risk of metabolic and cardiovascular complications in patients with chronic kidney disease. OBJECTIVE: To determine the prevalence and associated factors with abdominal obesity in patients on hemodialysis (HD). METHODS: Cross-sectional study with 344 patients older than 18 years. Abdominal obesity was defined as waist circumference > 94 cm in men and > 80 cm in women. The independent variables involved socioeconomic, demographic, lifestyle, duration of HD, food consumption and body mass index (BMI). The analysis of associated factors was performed by multiple Poisson regression, remaining in the final model variables with p < 0.05. RESULTS: The prevalence of abdominal obesity was 44.77% and was more prevalent in women (55.71%) than in men (37.25%), p = 0.001. The end result of the multivariate analysis identified factors associated with abdominal obesity in men and women: age over 40 years, protein intake below 1.2 g/kg/day and BMI > 25 kg/m². In men the economic class D/E remained associated with abdominal obesity, p < 0.05. CONCLUSION: There was a high prevalence of abdominal obesity in hemodialysis patients. Age greater than 40 years, lower socioeconomic classes, below the recommended protein intake and overweight were associated with abdominal obesity.