Influencia de las patologías relacionadas con el ingreso hospitalario sobre el estado nutricional de los pacientes en hemodiálisis / How do disorders related to hospitalisation influence haemodialysis patients' nutrition?

Introducción: Durante la hospitalización de pacientes en hemodiálisis crónica se produce un deterioro nutricional de origen multifactorial y que guarda relación con la duración de la estancia hospitalaria. El objetivo del estudio fue analizar si las patologías relacionadas con el ingreso influyen en el grado de deterioro nutricional sufrido durante el ingreso hospitalario. Pacientes y métodos: Seleccionamos retrospectivamente ingresos hospitalarios de pacientes en hemodiálisis crónica durante más de tres meses con una estancia superior a cuatro días, excluyendo aquellos casos que fallecieron en el hospital. Se eligió aleatoriamente un solo episodio de ingreso por paciente para evitar el peso excesivo de ingresos reiterados. Se recogieron cambios de peso, analítica preingreso y postingreso, analítica en primera semana de hospitalización, patologías causantes del ingreso y las aparecidas durante éste. Se construyó una puntuación para recoger el total de enfermedades presentadas. Resultados: El estudio incluyó a 77 pacientes con 67 ± 12 años y 31 ± 34 meses en hemodiálisis. La estancia hospitalaria fue de 17,8 ± 12,6 días (mediana, 12 días). Al considerar la causa de ingreso observamos una pérdida de peso algo mayor en pacientes ingresados por patología digestiva, osteoarticular, insuficiencia cardíaca o síndrome coronario, aunque sin alcanzar diferencias significativas. El número total de patologías sufridas durante el ingreso fue independiente del motivo de ingreso. La anemización, las arritmias cardíacas y la presencia de insuficiencia cardíaca se asociaron con una mayor estancia hospitalaria, siendo sólo la anemización la que se relacionó de forma significativa con mayor pérdida de peso. No se relacionaron con la pérdida de peso la realización de cirugía o la presencia de infecciones. La albúmina en la primera semana de hospitalización fue diferente según la patología del ingreso y fue más baja cuando ingresaron por patologías digestivas (ANOVA, p = 0,05). La variación de la albúmina y creatinina antes y después de la hospitalización no fue diferente según las patologías. Observamos una relación entre haber presentado un mayor número de patologías durante el ingreso con una mayor estancia, menor albúmina inicial y mayores pérdidas de peso tras el alta. Realizando análisis multivariante encontramos como predictores de la pérdida de peso la estancia, la anemización y la presencia de sepsis. Como predictores de la estancia encontramos el índice de comorbilidad de Charlson, la presencia de arritmia cardíaca, la anemización, la sepsis y la cirugía. Conclusiones: El deterioro nutricional durante la hospitalización depende de la duración de la estancia y del número de patologías sufridas durante el ingreso, influyendo menos el motivo de hospitalización. La albúmina se reduce de forma precoz en pacientes con ingresos que van a complicarse con un mayor número de patologías (AU)

Introduction: Hospitalised chronic haemodialysis patients often develop malnutrition due to many causes, which worsens throughout their hospital stay. The objective of the study is to analyse if the disorders related to hospitalisation influence the degree of malnutrition suffered during the hospital stay. Patients and Methods: Over a period of more than three months, we retrospectively chose chronic haemodialysis patients that were admitted for more than four days, excluding those cases that died in the hospital. We randomly chose one admission episode per patient so as to avoid excessive weighing of repeated admissions. We took data concerning weight changes, pre-admission and post-discharge analytical results, analytical results following first week of hospital stay, disorders causing hospital admission and those that developed during the hospital stay. We created a point score system to record the total of illnesses presented. Results: The study included 77 patients, aged 67±12 years and having undergone haemodialysis for 31±34 months. Hospital stay was 17.8±12.6 days (median, 12 days). We observed that many patients admitted for digestive and osteoarticular disorders, heart failure or coronary syndrome lost more weight during their hospital stay, although no significant differences were reached. The total number of disorders suffered during the hospital stay was independent of the cause of hospitalisation. Anaemia, heart arrhythmias and signs of heart failure were associated with longer hospital stays, however it was only anaemia that was significantly related to greater weight loss. Weight loss was not related to surgery or infections. Albumin levels during the first week of hospital stay were different depending on the disorder upon admission. It was lower when the patients were admitted for digestive disorders (ANOVA, P=.05). Changes in albumin and creatinine levels before and after the hospital stay did not differ among disorders. We observed a relationship between having presented with more disorders during the stay and a longer stay, lower initial albumin and greater weight loss following discharge. In the multivariate analysis, we found the following weight loss predictors: stay, anaemia, and sepsis. We also found the following hospital stay predictors: Charlson’s comorbidity index, heart arrhythmias, anaemia, sepsis and surgery. Conclusions: Malnutrition during the hospital stay depends on the duration and the number of disorders that develop during this time, the cause of admission having less impact on this. Albumin levels decrease earlier in patients that are going to develop more disorders during hospital stay (AU)

How do disorders related to hospitalisation influence haemodialysis patients' nutrition?

INTRODUCTION: Hospitalizations are frequent in hemodialysis patients and is often accompanied by nutritional deterioration showed by a loss of weight and a reduction of albumin serum levels. This phenomenon is related with length of stay having its origin in a complex interplay of factors. Our aim in this study was to analyze if changes in body weight and other nutritional parameters are influenced by the illnesses presented during hospitalization. PATIENTS AND METHODS: Over a period of three years, we retrospectively chose chronic haemodialysis patients that were admitted for more than four days, excluding those cases that died in the hospital. We randomly chose one admission episode per patient so as to avoid excessive weighing of repeated admissions. We took data concerning weight changes, pre-admission and post-discharge analytical results, analytical results following first week of hospital stay, disorders causing hospital admission and those that developed during the hospital stay. We created a point score system to record the total of illnesses presented. RESULTS: The study included 77 patients, aged 67±12 years and having undergone haemodialysis for 31±34 months. Hospital stay was 17.8±12.6 days (median, 12 days). We observed that many patients admitted for digestive and osteoarticular disorders, heart failure or coronary syndrome lost more weight during their hospital stay, although no significant differences were reached. The total number of disorders suffered during the hospital stay was independent of the cause of hospitalisation. Anaemia,heart arrhythmias and signs of heart failure were associated with longer hospital stays, however it was only anaemia that was significantly related to greater weight loss. Weight loss was not related to surgery or infections. Albumin levels during the first week of hospital stay were different depending on the disorder upon admission. It was lower when the patients were admitted for digestive disorders (ANOVA, P=.05). Changes in albumin and creatinine levels before and after the hospital stay did not differ among disorders. We observed a relationship between having presented with more disorders during the stay and a longer stay, lower initial albumin and greater weight loss following discharge. In the multivariate analysis, we found the following weight loss predictors: stay, anaemia, and sepsis. We also found the following hospital stay predictors:Charlson's comorbidity index, heart arrhythmias, anaemia, sepsis and surgery. CONCLUSIONS: Malnutrition during the hospital stay depends on the duration and the number of disorders that develop during this time, the cause of admission having less impact on this. Albumin levels decrease earlier in patients that are going to develop more disorders during hospital stay.

[Loss of weight in hemodialysis patients after hospitalization is related with length of stay and degree of inflammation]. / La pérdida de peso en pacientes en hemodiálisis tras su hospitalización tiene relación con la duración de la estancia y con el grado de inflamación.

BACKGROUND: It is frequent to observe that hemodialysis patients suffer important loss of weight during hospital stay. This issue has not been investigated previously. Our aim in this study was to analyze factors associated with this loss of weight and what changes occur after admission in biochemical parameters with nutritional interest. PATIENTS AND METHODS: We retrospectively selected patients undergoing chronic hemodialysis who were admitted at hospital for acute or chronic pathologies, with a minimum length of stay of 4 days, taking only one episode of admission per patient. We chose loss of weight observed at hospital discharge, at 2 and 4 weeks later and we also collected routine laboratory data and adequacy parameters before and after the hospital admission and basic biochemical parameters in the first week of hospital stay. RESULTS: We included 77 patients, with 67±12 years and 30±34 months in dialysis. Forty (51.9%) were female (51.9%) and 22 diabetics (28.6%). Length of stay was 17.8±12.6 days (median 12). There were 70.4% patients who suffered a loss of weight at discharge and 81.4% at 4 weeks, without differences in sex or diabetes. Weight decreased significantly with a mean of -1.09 kg (95%CI -0.73 to -1.44). After 2 weeks the loss of weight was -1.64 kg (95%CI -1.21 a -2.07 kg) and after 4 weeks was -1.94 kg (95%CI -1.47 a -2.42 kg). Comparing parameters before and after admission, we observed a significantly decrease in serum urea levels (before 134±40 vs after 119±36 mg/dl; p= 0.001), creatinine (before 8.1±2.6 vs after 7.5±2.6 mg/dl; p < 0.001), phosphate (before 5.2±1.7 vs after 4.3±1.5 mg/dl; p < 0.001) and albumin (before 3.70±0.48 vs after 3.56±0.58 g/dl; p=0.05), without changes in adequacy parameters. Greater loss of weight at 4 weeks from discharge was correlated with larger length of stay (r= 0.41; p < 0.001), greater body mass index at admission (r= -0.23; p=0.05) and lower serum albumin at admission (r= 0.39; p= 0.012). It was also correlated with a lower serum albumin (r= 0.27; p=0.05), lower creatinine (r= 0.30; p= 0.02) and lower protein intake (nPNA) (r= 0.47; p= 0.002) after discharge. Lower serum albumin levels at admission were correlated with greater decreases of creatinine after discharge (r= 0.42; p= 0.009) and larger length of stay (r= -0.61; p < 0.001). Employing multivariate analysis we found that loss of weight was associated to length of stay and serum potassium levels before admission. CONCLUSIONS: Hospitalization of hemodialysis patients have a negative nutritional impact causing a significant loss of weight, probably reflecting a reduction of muscle mass. We found that length of stay in hospital is a basic factor associated with this nutritional impairment. The pathologies promoting hospitalization could influence this derangement through inflammation but this hypothesis should be investigated.

La pérdida de peso en pacientes en hemodiálisis tras su hospitalización tiene relación con la duración de la estancia y con el grado de inflamación / Weight loss in haemodialysis patients following hospitalisation is related to the duration of hospital stay and level of inflammation

Introducción: En pacientes en hemodiálisis es frecuente observar pérdida de peso relacionada con el ingreso hospitalario. Nuestro objetivo fue cuantificar esta pérdida de peso y analizar con qué factores se relaciona. Pacientes y métodos: Seleccionamos a pacientes en hemodiálisis crónica, con ingresos hospitalarios por cualquier etiología con duración mínima de 4 días, recogiendo pérdidas de peso al alta, a las 2 y 4 semanas del alta, así como evolución de variables con interés nutricional (creatinina, albúmina, transferrina, nPNA) tras su alta. Resultados: Incluimos a 77 pacientes, con 67 ± 12 años y 30 ± 34 meses en hemodiálisis, 40 mujeres (51,9%) y 22 diabéticos (28,6%). La estancia hospitalaria fue 17,8 ± 12,6 días (mediana 12 días). El 70,4% mostraron pérdida de peso al alta y un 81,3% a las 4 semanas del alta, sin influir sexo ni diabetes. El peso disminuyó al alta -1,09 kg (IC 95%, -0,73 a -1,44), —1,64 kg (IC 95%, -1,21 a -2,07 kg) a las 2 semanas y -1,94 kg (IC 95%, -1,47 a -2,42 kg) a las 4 semanas. Tras el alta observamos un descenso de urea (antes del alta 134 ± 40 frente a después del alta 119 ± 36 mg/dl; p = 0,001), creatinina (antes del alta 8,1 ± 2,6 frente a después del alta 7,5 ± 2,6 mg/dl; p <0,001), fósforo (antes del alta 5,2 ± 1,7 frente a después del alta 4,3 ± 1,5 mg/dl; p <0,001), albúmina (antes del alta 3,70 ± 0,48 frente a después del alta 3,56 ± 0,58 g/dl; p = 0,05). La pérdida de peso a las 4 semanas se correlacionó con una mayor estancia hospitalaria (r = 0,41; p <0,001), mayor índice de masa corporal en el momento del ingreso (r = —0,23; p = 0,05) y menor albúmina en el ingreso (r = 0,39; p = 0,012) y con albúmina (r = 0,27; p = 0,05), creatinina (r = 0,30; p = 0,02) y nPNA (r = 0,47; p = 0,002) más bajos después del ingreso. Albúminas más bajas en el momento del ingreso se correlacionaron con mayores descensos de la creatinina después del ingreso (r = 0,42; p = 0,009) y con una estancia más prolongada (r = —0,61; p <0,001). Con análisis multivariante, la pérdida de peso se asoció con mayor duración de estancia y con potasio sérico antes del ingreso. Conclusiones: La hospitalización de pacientes en hemodiálisis provoca una pérdida significativa del peso corporal debido a una probable pérdida de la masa muscular. La mayor estancia hospitalaria y el estado inflamatorio durante el ingreso son los factores que se relacionan con el deterioro nutricional que sufren los pacientes en hemodiálisis durante su hospitalización (AU)

Background: It is frequent to observe that hemodialysis patients suffer important loss of weight during hospital stay. This issue has not been investigated previously. Our aim in this study was to analyze factors associated with this loss of weight and what changes occur after admission in biochemichal parameters with nutritional interest. Patients and methods: We retrospectively selected patients undergoing chronic hemodialysis who were admitted at hospital for acute or chronic pathologies, with a minimum length of stay of 4 days, taking only one episode of admission per patient. We chose loss of weight observed at hospital discharge, at 2 and 4 weeks later and we also collected routine laboratory data and adecuacy parameters before and after the hospital admission and basic biochemical parameters in the first week of hospital stay. Results: We included 77 patients, with 67±12 years and 30±34 months in dialysis. Forty (51,9%) were female (51,9%) and 22 diabetics (28,6%). Length of stay was 17,8±12,6 days (median 12). There were 70,4% patients who suffered a loss of weight at discharge and 81,4% at 4 weeks, without differences in sex or diabetes. Weight decreased significantly with a mean of -1,09 kg (95%CI -0,73 to -1,44). After 2 weeks the loss of weight was -1,64 kg (95%CI -1,21 a -2,07 kg) and after 4 weeks was -1,94 kg (95%CI -1,47 a -2,42 kg). Comparing parameters before and after admission, we observed a significantly decrease in serum urea levels (before 134±40 vs after 119±36 mg/dl; p= 0,001), creatinine (before 8,1±2,6 vs after 7,5±2,6 mg/dl; p<0,001), phosphate (before 5,2±1,7 vs after 4,3±1,5 mg/dl; p< 0,001) and albumin (before 3,70±0,48 vs after 3,56±0,58 g/dl; p=0,05), without changes in adequacy parameters. Greater loss of weight at 4 weeks from discharge was correlated with larger length of stay (r= 0,41; p<0,001), greater body mass index at admission (r= -0,23; p=0,05) and lower serum albumin at admission (r= 0,39; p= 0,012). It was also correlated with a lower serum albumin (r= 0,27; p=0,05), lower creatinine (r= 0,30; p= 0,02) and lower protein intake (nPNA) (r= 0,47; p= 0,002) after discharge. Lower serum albumin levels at admission were correlated with greater decreases of creatinine after discharge (r= 0,42; p= 0,009) and larger length of stay (r= -0,61; p<0,001). Employing multivariate analysis we found that loss of weight was associated to length of stay and serum potasium levels before admission. Conclusions: Hospitalization of hemodialysis patients have a negative nutritional impact causing a significant loss of weight, probably reflecting a reduction of muscle mass. We found that length of stay in hospital is a basic factor associated with this nutritional impairment. The pathologies promoting hospitalization could influence this derangement through inflammation but this hypothesis should be investigated (AU)