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评估维持性血液透析患者的营养状况:来自巴勒斯坦的一项横断面研究。

Assessment of nutritional status in the maintenance of haemodialysis patients: a cross-sectional study from Palestine.

机构信息

Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.

Department of Physiology, Pharmacology, and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.

出版信息

BMC Nephrol. 2019 Mar 15;20(1):92. doi: 10.1186/s12882-019-1288-z.

Abstract

BACKGROUND

Protein-energy wasting (PEW) is a relatively prevalent problem among adult haemodialysis patients (HDP). PEW is an important determinant of morbidity and mortality in HDP, therefore it is essential for dietitians to accurately assess malnutrition (MN) in these patients. HDP appear to be more susceptible to developing MN; however, this is not well documented. Therefore this study aimed to assess the nutritional status among HDP and to establish the factors associated with MN in these patients.

METHODS

A cross-sectional survey was carried out in Nablus, northern West Bank, in the main haemodialysis (HD) centre at the An-Najah National University Hospital. MN was detected using the malnutrition-inflammation scale (MIS), which involved four major elements: the patient's related medical history, their body mass index, a physical examination and laboratory parameters.

RESULTS

A total of 174 patients (91 male) were included in the study. Patients were aged 57.7 ± 12.8 years, and the median dialysis vintage was 3 years (interquartile range 1-5 years). HDP, especially the elderly (unstandardized coefficient β, 1.728; 95% CI, 0.700 to 2.756; P = 0.001), those with multiple comorbid diseases (unstandardized coefficient β, 1.673; 95% CI, 0.556 to 2.789; P = 0.004); those taking multiple chronic medications (unstandardized coefficient β, 1.259; 95% CI, 0.197 to 2.321; P = 0.020), or those with a long dialysis vintage (unstandardized coefficient β, 1.449; 95% CI, 0.410 to 2.487; P = 0.007), were positively associated with the MIS score in a multivariable linear regression model. Furthermore, HDP living with their family were negatively associated with the MIS score (unstandardized coefficient β, - 2.545; 95% CI, - 4.738 to - 0.352; P = 0.023).

CONCLUSIONS

The MIS score results indicate that MN is prevalent among HDP. These results demonstrate some correlations between nutritional status and patient characteristics (i.e. clinical and sociodemographic factors). Therefore these findings should help to increase the awareness of healthcare providers for interventions to enhance the nutritional status of HDP, especially those who are elderly, have multiple comorbid diseases, have multiple chronic medications, have experienced a long dialysis vintage or who live alone.

摘要

背景

蛋白能量消耗(PEW)是成年血液透析患者(HDP)中较为普遍的问题。PEW 是 HDP 发病率和死亡率的重要决定因素,因此营养师必须准确评估这些患者的营养不良(MN)。HDP 似乎更容易发生 MN;然而,这一点并没有得到很好的记录。因此,本研究旨在评估 HDP 的营养状况,并确定这些患者发生 MN 的相关因素。

方法

在约旦河西岸北部纳布卢斯的 An-Najah 国立大学医院主要血液透析(HD)中心进行了一项横断面调查。使用营养不良-炎症量表(MIS)检测 MN,该量表涉及四个主要元素:患者的相关病史、体重指数、体格检查和实验室参数。

结果

共有 174 名患者(91 名男性)纳入研究。患者年龄为 57.7±12.8 岁,中位透析龄为 3 年(四分位距 1-5 年)。HDP,尤其是老年人(未标准化系数β,1.728;95%置信区间,0.700 至 2.756;P=0.001)、患有多种合并症(未标准化系数β,1.673;95%置信区间,0.556 至 2.789;P=0.004)、服用多种慢性药物(未标准化系数β,1.259;95%置信区间,0.197 至 2.321;P=0.020)或透析龄较长(未标准化系数β,1.449;95%置信区间,0.410 至 2.487;P=0.007)的患者,在多变量线性回归模型中与 MIS 评分呈正相关。此外,与家人同住的 HDP 与 MIS 评分呈负相关(未标准化系数β,-2.545;95%置信区间,-4.738 至-0.352;P=0.023)。

结论

MIS 评分结果表明,MN 在 HDP 中较为普遍。这些结果表明营养状况与患者特征(即临床和社会人口统计学因素)之间存在一些相关性。因此,这些发现应有助于提高医疗保健提供者对干预措施的认识,以增强 HDP 的营养状况,特别是那些年龄较大、患有多种合并症、服用多种慢性药物、透析龄较长或独居的患者。

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