Barros Annerose, da Costa Bartira E Pinheiro, Poli-de-Figueiredo Carlos E, Antonello Ivan C, d'Avila Domingos O
School of Medicine, Institute of Biomedical Research, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
Ther Apher Dial. 2011 Feb;15(1):58-65. doi: 10.1111/j.1744-9987.2010.00874.x. Epub 2010 Oct 29.
Hemodialysis therapy significantly impacts on patients' physical, psychological, and social performances. Such reduced quality of life depends on several factors, such as malnutrition, depression, and metabolic derangements. This study aims to evaluate the current nutritional status, quality of life and depressive symptoms, and determine the possible relationships with other risk factors for poor outcomes, in stable hemodialysis patients. This was a single-center, cross-sectional study that enrolled 59 adult patients undergoing hemodialysis. Laboratory tests that included high-sensitivity c-reactive protein (CRP), and quality of life and depressive symptom evaluation, as well as malnutrition-inflammation score, nutritional status and body composition (by direct segmental multi-frequency bioimpedance analysis) determinations were performed. Patients were classified as "underfat", "standard", "overfat", or "obese" by multi-frequency bioimpedance analysis. Seven patients were underfat, 19 standard, 19 overfat, and 14 obese. Triglyceride levels significantly differed between the underfat, standard, overfat, and obese groups (1.06 [0.98-1.98]; 1.47 [1.16-1.67]; 2.53 [1.17-3.13]; 2.12 [1.41-2.95] mmol/L, respectively; P=0.026), as did Kt/V between the underfat, overfat, and obese groups (1.49 ± 0.14; 1.23 ± 0.19; 1.19 ± 0.22; P=0.015 and P=0.006, respectively). Depressive symptoms, quality of life, and CRP and phosphate levels did not diverge among nutritional groups. Creatinine, albumin, and phosphate strongly correlated, as well as percent body fat, body mass index, and waist circumference (r=0.859 [P<0.001], and r=0.716 [P<0.001], respectively). Depressive symptoms and physical and psychological quality-of-life domains also strongly correlated (r(s) = -0.501 [P<0.001], r(s) = -0.597 [P<0.001], respectively). The majority of patients were overfat or obese and very few underfat. Inflammation was prevalent, overall. No association of nutritional status with malnutrition-inflammation, quality of life, or depressive symptoms could be established.
血液透析治疗对患者的身体、心理和社会表现有显著影响。这种生活质量下降取决于多种因素，如营养不良、抑郁和代谢紊乱。本研究旨在评估稳定血液透析患者的当前营养状况、生活质量和抑郁症状，并确定与其他不良预后风险因素之间可能存在的关系。这是一项单中心横断面研究，纳入了59例接受血液透析的成年患者。进行了包括高敏C反应蛋白（CRP）在内的实验室检查、生活质量和抑郁症状评估，以及营养不良-炎症评分、营养状况和身体成分（通过直接节段多频生物电阻抗分析）测定。通过多频生物电阻抗分析将患者分为“过瘦”、“标准”、“超重”或“肥胖”。7例过瘦，19例标准，19例超重，14例肥胖。过瘦、标准、超重和肥胖组之间的甘油三酯水平有显著差异（分别为1.06[0.98 - 1.98]；1.47[1.16 - 1.67]；2.53[1.17 - 3.13]；2.12[1.41 - 2.95]mmol/L；P = 0.026），过瘦、超重和肥胖组之间的Kt/V也有显著差异（分别为1.49±0.14；1.23±0.19；1.19±0.22；P分别为0.015和0.006）。抑郁症状、生活质量以及CRP和磷酸盐水平在营养组之间没有差异。肌酐、白蛋白和磷酸盐之间以及体脂百分比、体重指数和腰围之间有很强的相关性（r分别为0.859[P < 0.001]和0.716[P < 0.001]）。抑郁症状与身体和心理生活质量领域也有很强的相关性（r(s)分别为 - 0.501[P < 0.001]， - 0.597[P < 0.001]）。大多数患者超重或肥胖，过瘦的很少。总体而言，炎症普遍存在。无法确定营养状况与营养不良-炎症、生活质量或抑郁症状之间的关联。
