Department of Internal Medicine and Clinical Nutrition, Kayseri City Training and Research Hospital, 38080 Kayseri, Turkey.
Department of Nephrology, Uludag University Medical Faculty, 16059, Bursa, Turkey.
J Trace Elem Med Biol. 2020 Jul;60:126498. doi: 10.1016/j.jtemb.2020.126498. Epub 2020 Mar 19.
Nutritional status and micronutrient levels of end stage renal disease (ESRD) patients may vary depending on the mode of renal replacement therapy (RRT). We aimed to compare the effects of hemodialysis, peritoneal dialysis (PD) and renal transplantation (RT) on micronutrient levels and nutritional status in ESRD patients.
A total of 77 ESRD patients who had not received RRT were included in this prospective longitudinal study. All ESRD patients underwent a blood serum analysis that assessed the micronutrients such as selenium, copper, zinc, chromium, retinol, thiamine and vitamin B6 as well as a nutritional status assessment. After the baseline assessments and the initiation of RRT was accomplished, all patients were followed for 6 months.
The study showed significant improvements in subjective global assessment scores (percentage increases in score A were 26.6 and 36.6; p = 0.039 and p = 0.001; respectively), mid-arm circumference and the skin-fold thicknesses (p < 0.001, p < 0.001; respectively) in the RT and hemodialysis groups. The examinations at sixth month revealed a significant increase in body weight (4.8 kg; p = 0.002) and albumin levels (0.6 g/dL; p < 0.001) in only RT group. Zinc, thiamin and vitamin B6 were the most deficient micronutrients (44.1 %, 24.7 % and 35.1 %; respectively) in ESRD patients. There was a significant increase in selenium and retinol levels (p = 0.020 and p < 0.001; respectively) but a significant decrease in thiamin levels (p = 0.041) in RT patients. A significant increase in retinol levels (p = 0.028) and a significant decrease in thiamin levels (p = 0.022) was observed in the hemodialysis patients. However, no significant change in micronutrient levels was observed in the PD patients.
The results support the recommendation that ESRD patients should be supplemented with water-soluble vitamins, especially thiamine and vitamin B6, and trace elements, especially zinc. RT appears to be superior to other modes of RRT when examining SGA score, anthropometric measurements, albumin and micronutrient levels.
终末期肾病（ESRD）患者的营养状况和微量营养素水平可能因肾脏替代治疗（RRT）的模式而异。我们旨在比较血液透析、腹膜透析（PD）和肾移植（RT）对 ESRD 患者微量营养素水平和营养状况的影响。
本前瞻性纵向研究纳入了 77 名未接受 RRT 的 ESRD 患者。所有 ESRD 患者均进行了血清分析，评估了硒、铜、锌、铬、视黄醇、硫胺素和维生素 B6 等微量营养素以及营养状况评估。在基线评估后并开始进行 RRT 后，所有患者均随访 6 个月。
研究显示，RT 和血液透析组的主观整体评估评分（评分增加百分比分别为 26.6%和 36.6%；p=0.039 和 p=0.001）、上臂中部周长和皮褶厚度（p<0.001，p<0.001）均有显著改善。第 6 个月的检查显示，仅 RT 组的体重（4.8kg；p=0.002）和白蛋白水平（0.6g/dL；p<0.001）显著增加。锌、硫胺素和维生素 B6 是 ESRD 患者最缺乏的微量营养素（分别为 44.1%、24.7%和 35.1%）。RT 患者的硒和视黄醇水平显著升高（p=0.020 和 p<0.001），但硫胺素水平显著下降（p=0.041）。血液透析患者的视黄醇水平显著升高（p=0.028），硫胺素水平显著下降（p=0.022）。然而，PD 患者的微量营养素水平没有明显变化。
这些结果支持建议，即 ESRD 患者应补充水溶性维生素，尤其是硫胺素和维生素 B6，以及微量元素，尤其是锌。在评估 SGA 评分、人体测量学测量、白蛋白和微量营养素水平时，RT 似乎优于其他 RRT 模式。
