Hemodiyaliz ve periton diyalizi hastalarının beslenme durumlarının değerlendirilmesi: Bir üniversite hastanesi örneği
Abstract
Türkiye Kronik Böbrek Hastalığı prevelans çalışmasına göre 2008 yılında Türkiye'deki kronik böbrek hastalığı prevelansı erişkin popülasyonda %15,7 olarak bulunmuştur. Hemodiyaliz ve periton diyalizi hastalarında nutrisyon durumunun tek parametre ile belirlenmesi mümkün olamamaktadır. Bu çalışmada diyaliz hastalarının günlük beslenme durumları belirlenerek, biyokimyasal parametreleri ve antropometrileri incelenerek, morbidite ve mortaliteyi azaltmak için önerilerin geliştirilmesi amaçlanmıştır. Bu çalışmaya Uludağ Üniversitesi Sağlık Uygulama ve Araştırma Merkezi Periton Diyalizi Polikliniği'nde takip edilen, Periton Diyalizi programında olan 33 periton diyalizi hastası ve Uludağ Üniversitesi Sağlık Uygulama ve Araştırma Merkezi Hemodiyaliz Kliniği'nde hemodiyaliz tedavisi alan ve glomerül filtrasyon hızı 15'in altında 38 hemodiyaliz hastası dahil edilmiştir. Hastaların anket formu, besin tüketim kaydı ve biyokimyasal parametreleri baz alınmıştır. Besin tüketim kayıtları değerlendirildiğinde hemodiyaliz hastalarının 25,77±9,81 kcal/kg/gün enerji, 0,99±0,44 g/kg/gün protein aldığı ve enerjinin %43,51±7,62'si karbonhidrattan, %40,41±7,56'sının yağdan geldiği saptanmıştır. Periton diyalizi hastalarının 28,41±10,51 kcal/kg/gün enerji, 1,01±0,44 g/kg/gün protein aldığı ve enerjinin %49,91±7,83'ünün karbonhidrattan ve %34,78±6,57'sinin yağdan geldiği belirlenmiştir. Özellikle enerji ve protein düzeylerinin referans değerlerin oldukça altında kaldığı görülmüştür. Hastaların malnutrisyon değerlendirilmesinde, hemodiyaliz hastalarının %13,2'sinin, periton diyalizi hastalarının %6,1'inin malnutrisyon riski altında olduğu belirlenmiştir. Hastaların besin tüketimlerinde fosfor alımları, önerilen referans aralığında; vitamin B1 ve B6 alımlarının ise yetersiz olduğu saptanmıştır. Posa tüketimleri düşük düzeylerde saptanmıştır. Biyokimyasal parametreler incelendiğinde ortalama albümin 3,61±0,4 g/ml olarak yetersiz görülmüştür. Ortalama sodyum düzeyi 137,31±3,09 mmol/l, potasyum düzeyi 4,87±0,8 mmol/l olarak referans aralıklarının içinde ve fosfor düzeyi 5,06±1,2 mg/dl olarak referans aralığından fazla bulunmuştur. Sonuç olarak diyaliz hastalarının beslenme durumları incelendiğinde, çoğunun yetersiz beslendiği, hafif düzeyde malnutrisyon riski altında oldukları ve diyete uyumun düşük olduğu saptanmıştır. Anahtar Kelimeler: Kronik böbrek hastalığı, Hemodiyaliz, Periton diyalizi, NRS-2002.
According to the prevalence study of Chronic Kidney Disease in Turkey; chronic kidney disease prevalence in Turkey was found 15.7% in adult population in 2008. It is not possible for nutritional status of hemodialysis and peritoneal dialysis patients to be specified with a single parameter. The aim of this study is to determine daily nutritional status of dialysis patients and present recommendations in order to decrease the rate of morbidity and mortality by examining the biochemical parameters and anthropometrics. 33 peritoneal dialysis patients from Peritoneal Dialysis program conducted in Uludag University Healthcare Practices and Research Center Peritoneal Dialysis Polyclinic, and 38 hemodialysis patients whose glomerular filtration rate is below 15 receiving hemodialysis treatment in Uludag University Healthcare Practices and Research Center Hemodialysis Clinic were included in this study. A questionnaire and the forms of food consumption were applied to the patients and biochemical parameters were considered accordingly. When the food consumption levels of hemodialysis patients were considered, it has been found that the energy amount of hemodialysis patients was 25.77±9.81 kcal/kg/day, their protein amount was 0.99±0.44 g/kg/day, their carbohydrate rate was 43.51%±7.62 and the fat rate was 40.41%±7.56. The energy amount of peritoneal dialysis patients was found to be 28.41±10.51 kcal/kg/day, protein amount was 1.01±0.44 g/kg/day, carbohydrate rate was 49.91%±7.83 and the fat rate was found as 34.78%±6.57. It was noted that especially their energy and protein levels were much lower than the reference values. 6.1% of patients of peritoneal dialysis and 13.2% of hemodialysis patients were found to be at risk of malnutrition. In the food consumption of patients, phosphorus intake, the recommended reference range; vitamin B1 and vitamin B6 intake were found to be inadequate. The fibre consumptions were found to be at low rates. The average albumin 3.61±0.4 g/dl wasseen to be inadequate according to the analysis of the biochemical parameters. Sodium and potassium levels were found in reference ranges as 137.31±3.09 mmol/l and 4.87±0.8 mmol/l respectively. On the contrary, phosphorus level was found to be higher than the reference range as 5.06±1.2 mg/dl. As a conclusion, when analyzing nutritional status of the dialysis patients, it has been stated thatmost of them receive inadequate nourishment and they are slightly under the risk of malnutrition and their adaptation to a diet is low. Keywords: Chronic kidney disease, Hemodialysis, Peritoneal dialysis, NRS2002.
According to the prevalence study of Chronic Kidney Disease in Turkey; chronic kidney disease prevalence in Turkey was found 15.7% in adult population in 2008. It is not possible for nutritional status of hemodialysis and peritoneal dialysis patients to be specified with a single parameter. The aim of this study is to determine daily nutritional status of dialysis patients and present recommendations in order to decrease the rate of morbidity and mortality by examining the biochemical parameters and anthropometrics. 33 peritoneal dialysis patients from Peritoneal Dialysis program conducted in Uludag University Healthcare Practices and Research Center Peritoneal Dialysis Polyclinic, and 38 hemodialysis patients whose glomerular filtration rate is below 15 receiving hemodialysis treatment in Uludag University Healthcare Practices and Research Center Hemodialysis Clinic were included in this study. A questionnaire and the forms of food consumption were applied to the patients and biochemical parameters were considered accordingly. When the food consumption levels of hemodialysis patients were considered, it has been found that the energy amount of hemodialysis patients was 25.77±9.81 kcal/kg/day, their protein amount was 0.99±0.44 g/kg/day, their carbohydrate rate was 43.51%±7.62 and the fat rate was 40.41%±7.56. The energy amount of peritoneal dialysis patients was found to be 28.41±10.51 kcal/kg/day, protein amount was 1.01±0.44 g/kg/day, carbohydrate rate was 49.91%±7.83 and the fat rate was found as 34.78%±6.57. It was noted that especially their energy and protein levels were much lower than the reference values. 6.1% of patients of peritoneal dialysis and 13.2% of hemodialysis patients were found to be at risk of malnutrition. In the food consumption of patients, phosphorus intake, the recommended reference range; vitamin B1 and vitamin B6 intake were found to be inadequate. The fibre consumptions were found to be at low rates. The average albumin 3.61±0.4 g/dl wasseen to be inadequate according to the analysis of the biochemical parameters. Sodium and potassium levels were found in reference ranges as 137.31±3.09 mmol/l and 4.87±0.8 mmol/l respectively. On the contrary, phosphorus level was found to be higher than the reference range as 5.06±1.2 mg/dl. As a conclusion, when analyzing nutritional status of the dialysis patients, it has been stated thatmost of them receive inadequate nourishment and they are slightly under the risk of malnutrition and their adaptation to a diet is low. Keywords: Chronic kidney disease, Hemodialysis, Peritoneal dialysis, NRS2002.
Description
Keywords
Beslenme ve Diyetetik, Beslenme, Beslenme durumu, Böbrek hastalıkları, Nutrition and Dietetics, Nutrition, Böbrek yetmezliği-kronik, Nutritional status, Kidney diseases, Malnütrisyon, Kidney failure-chronic, Periton diyalizi, Malnutrition, Peritoneal dialysis, Renal diyaliz, Renal dialysis