RESUMO
Chronic kidney disease-associated pruritus (CKD-aP) is one of the most common and disabling comorbidities in patients with advanced CKD. In addition, it is associated with an increased risk of mortality, poorer quality of life, sleep disorders, mental health disorders, and increased use of health care resources. The clinical presentation of CKD-aP is very heterogeneous, making it difficult to diagnose and treat. Currently, there are no national guidelines on the management of CKD-aP. The aim of this document is to provide national consensus recommendations for the diagnostic and therapeutic management of CKD-aP. The document was prepared in three phases: a diagnostic and therapeutic management algorithm was proposed by a small group of nephrology specialists; the proposal was validated by a larger group of nephrologists; and a second validation by a multidisciplinary group that also included dermatology specialists. The diagnostic and therapeutic management algorithm attempts to cover the current need of a lack of specific guidelines for the adequate management of CKD-aP. At the same time, it introduces the use of difelikefalin, the first and only drug specifically approved for CKD-aP, with a good safety and efficacy profile.
RESUMO
BACKGROUND: Diet is one of the pillars of the treatment for patients with chronic kidney disease without dialysis (NDD-CKD). Despite this, very few studies have evaluated the diet in Spanish population. OBJECTIVE: To evaluate the diet of a group of patients with advanced CKD, comparing it with the recommendations, and its relation with nutritional status. MATERIAL AND METHODS: A cross-sectional study of 74 patients (39 men), with a mean age of 70.9 ± 13.6 years and creatinine clearance of 15.3 ± 2.1 mL/min. Biochemical, anthropometric and intake variables (3-day dietary record) were collected, comparing them with the recommendations for patients with CKD and, if they did not exist, with nutritional recommendations and objectives for the Spanish population. The nutritional status was assessed by modified criteria of protein-energy wasting (PEW). RESULTS: The mean energy intake was 23.2 ± 6.5 kcal/kg body weight/day, and the protein intake was 0.93 ± 0.2 g/kg body weight/day. Men had a higher intake of alcohol and vitamin D whereas women presented a higher intake of trans fatty acids and vitamin B1. In addition, 91.4% of patients had high intake of phosphorus and 73% of potassium. Only 2.7% showed an adequate intake of vitamin D and 21.6% of folates; 18.9% of patients presented PEW. A positive correlation was found between albumin, body mass index (BMI) and creatinine clearance. CONCLUSION: Most patients with non-dialysis CKD do not meet dietary recommendations or nutritional goals, regardless of gender and PEW status, considering renal function as a limiting factor.
Assuntos
Dieta , Estado Nutricional , Insuficiência Renal Crônica/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , EspanhaRESUMO
Introducción: la dieta en los pacientes con enfermedad renal crónica (ERC) sin diálisis es uno de los pilares de su tratamiento. A pesar de esto existen muy pocos estudios que hayan evaluado la dieta en esta población y ninguno en población española. Objetivo: evaluar la dieta de un colectivo de pacientes con ERC avanzada, comparándola con las recomendaciones, y su relación con marcadores del estado nutricional. Material y métodos: estudio transversal de 74 pacientes (39 hombres), con edad media de 70,9 ± 13,6 años y aclaramiento de creatinina 15,3 ± 2,1 mL/min. Se recogieron variables bioquímicas, antropométricas y de ingesta (registro dietético de tres días), que fueron comparadas con las recomendaciones para pacientes con ERC y, si no existían, con las recomendaciones y objetivos nutricionales para población española. Se valoró el estado nutricional mediante criterios modificados de desgaste proteico energético (DPE). Resultados: la ingesta energética media fue de 23,2 ± 6,5 kcal/kg peso/día y la ingesta proteica, de 0,93 ± 0,2 g/kg peso/día. Los hombres presentaban una ingesta mayor de alcohol y vitamina D y las mujeres, de ácidos grasos trans y vitamina B1. Un 91,4% presentaba ingesta elevada de fósforo y un 73%, de potasio. Solo el 2,7% presentaba ingesta adecuada de vitamina D y el 21,6%, de folatos. El 18,9% presentaba DPE. Se encontró una correlación positiva entre albúmina, índice de masa corporal (IMC) y aclaramiento de creatinina. Conclusión: la mayoría de los pacientes con ERC sin diálisis no cumplen las recomendaciones de ingesta ni los objetivos nutricionales, independientemente del sexo y de la situación de DPE, considerando la función renal como un factor limitante (AU)
Background: Diet is one of the pillars of the treatment for patients with chronic kidney disease without dialysis (NDD-CKD). Despite this, very few studies have evaluated the diet in Spanish population. Objective: To evaluate the diet of a group of patients with advanced CKD, comparing it with the recommendations, and its relation with nutritional status. Material and methods: A cross-sectional study of 74 patients (39 men), with a mean age of 70.9 ± 13.6 years and creatinine clearance of 15.3 ± 2.1 mL/min. Biochemical, anthropometric and intake variables (3-day dietary record) were collected, comparing them with the recommendations for patients with CKD and, if they did not exist, with nutritional recommendations and objectives for the Spanish population. The nutritional status was assessed by modified criteria of protein-energy wasting (PEW). Results: The mean energy intake was 23.2 ± 6.5 kcal/kg body weight/day, and the protein intake was 0.93 ± 0.2 g/kg body weight/day. Men had a higher intake of alcohol and vitamin D whereas women presented a higher intake of trans fatty acids and vitamin B1. In addition, 91.4% of patients had high intake of phosphorus and 73% of potassium. Only 2.7% showed an adequate intake of vitamin D and 21.6% of folates; 18.9% of patients presented PEW. A positive correlation was found between albumin, body mass index (BMI) and creatinine clearance. Conclusion: Most patients with non-dialysis CKD do not meet dietary recommendations or nutritional goals, regardless of gender and PEW status, considering renal function as a limiting factor (AU)
