Comparison of Subjective Global Assessment with Objective Parameters in Patients Maintaining Hemodialysis Treatment: A Cross-Sectional Study
Öz
Aim: There are two kinds of nutritional status assessment for patients which maintain hemodialysis treatment. One of them is the
objective and the other is the subjective scoring system. In this
study, hypoalbuminemia which is suggested as a diagnostic marker for malnutrition by the International Society of Renal Nutrition
and Metabolism (ISRNM) is compared with sga scoring system for
the patients biodemographic features.
Material and Method: This cross-sectional study was conducted
with the datas of 191 patients maintaining hemodialysis treatment
in four public hemodialysis centers located in Kars and Ardahan.
Patients seperated into two groups according to SGA score and
serum albumin levels. The group which dependent variable is SGA
is further divided into two according to their nutritional Status which
is good and not good (SGA score: 1–14 and 15–49) and the other
group which dependent variable is serum albümin is further divided
into two as well (serum albümin levels: lower than 3.8 g/dl and higher than 3.8 g/dl). Patients age, duration of hemodialysis, vascular access, diabetes mellitus presence are considered as the independent
variables and are compared with dependent variables.
Results: The analysis results of 191 patients datas revealed that,
the percentage of patients whose nutritional Status is not fine is
39%, serum albümin levels lower than 3.8 g/dl is 51.3%, womens
percentage is 40.8, age 65 and older is 51.3%, duration of hemodialysis gelonger than 5 years is 40.8%, barody mass Index below 23
is 43.5%, Kt/V ratio lower than the target value is 22.5%. There is
no significant statistical difference between SGA score and independent variables. The objective parameter serum albümin levels
and patients gender, Kt/V ratio, anemisi, serum CRP, vascular access have significant statistical differences.
Conclusion: In hemodialysis patients, objective parameters are
more effective markers than SGA in evaluating nutritional status.
Anahtar Kelimeler
subjective global assessment; hypoalbuminemia in hemodialysis patients; malnutrition
Kaynakça
- 1. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008;73(4):391–98. 2. Fiedler R, Jehle PM, Osten B, Dorligschaw O, Girndt M. Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance. Nephrology Dialysis Transplantation 2009;24:3812–17. 3. Cooper BA, Bartlett LH, Aslani A, Allen BJ, Ibels LS, Pollock CA. Validity of subjective global assessment as a nutritional marker in end-stage renal disease. Am J Kidney Dis 2002;40(1):126–32. 4. Enia G, Sicuso C, Alati G, Zoccali C. Subjective global assessment of nutrition in dialysis patients. Nephrology Dialysis Transplantation 1993;8(10):1094–98. 5. Canada-USA Peritoneal Dialysis Study Group. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol 1996;7(2):198–207. 6. Fouque D, Vennegoor M, Wee PT, Wanner C, Basci A, Canaud B, et al. EBPG guideline on nutrition. Nephrology Dialysis Transplantation 2007;22(2): ii45-ii87. 7. Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, et al. KDOQI clinical practice guideline for hemodialysis adequacy:2015 update. Am J Kidney Dis 2015;66(5):884–930. 8. Kovesdy C, Regidor DL, Mehrotra R, Jing J, McAllister CJ, Greenland S, et al. Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol 2007;2:999–1007. 9. Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKDMBD) Guideline Update: what’s changed and why it matters. Kidney international 2017;92(1):26–36. 10. Steiber AL, Kalantar-Zadeh K, Secker D, McCarthy M, Sehgal A, McCann L. Subjective Global Assessment in chronic kidney disease: a review. J Ren Nutr 2004;14(4):191–200. 11. Fiedler R, Jehle PM, Osten B, Dorligschaw O, Girndt M. Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance. Nephrology Dialysis Transplantation 2009;24:3812–17. 12. Kalantar-Zadeh K, Block G, McAllister CJ, Humphreys MH, Kopple JD. Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr 2004;80(2):299–307. 13. Kaysen GA, Dubin JA, Müller HG, Mitch WE, Rosales LM, Levin NW. Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients. Kidney international 2002;61(6):2240–49. 14. Goldstein SL, Ikizler TA, Zappitelli M, Silverstein DM, Ayus JC. Non-infected hemodialysis catheters are associated with increased inflammation compared to arteriovenous fistulas. Kidney Int 2009;76(10):1063–69. 15. Fouque D, Pelletier S, Guebre-Egziabher F. Have recommended protein and phosphate intake recently changed in maintenance hemodialysis?. J Ren Nutr 2011;21(1):35–38. 16. Kimata N, Karaboyas A, Bieber BA, Pisoni RL, Morgenstern H, Gillespie BW, et al. Gender, low Kt/V, and mortality in Japanese hemodialysis patients: opportunities for improvement through modifiable practices. Hemodial Int 2014;18(3):596–606. 17. Qureshi AR, Alvestrand A, Danielsson A, Divino-Filho JC, Gutierrez A, Lindholm B, et al. Factors predicting malnutrition in hemodialysis patients: a cross-sectional study. Kidney international 1998;53(3):773–82. 18. Kadiri MEMB, Nechba RB, Oualim Z. Factors predicting malnutrition in hemodialysis patients. Saudi J Kidney Dis Transpl 2011;22(4):695–704. 19. Stoian I, Manolescu B, Atanasiu V, Lupescu O, Buşu C. IL-6- STAT-3-hepcidin: linking inflammation to the iron metabolism. Rom J Intern Med 2007;45(3):305–09. 20. Kalantar-Zadeh K, Rodriguez RA, Humphreys MH. Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients. Nephrology Dialysis Transplantation 2004;19(1):141–49
Hemodiyaliz Tedavisi Sürdürenlerde “Subjektif Global Değerlendirme” ile Objektif Parametrelerin Karşılaştırılması: Kesitsel Araştırma
Öz
Amaç: Hemodiyaliz tedavisi sürdüren hastaların nutrisyonel durumunun bozulmasının göstergeleri olarak serum albümin düzeyi,
günlük protein alımı, kas kitle ölçüm değerlendirmeleri gibi objektif parametrelerin yanısıra ‘Subjektif Global Değerlendirme”(SGD)
olarak adlandırılan skorlama ile de değerlendirilmektedir. Bu araştırmada Uluslararası Böbrek Nutrisyon ve Metabolizma Derneği
(ISRNM) tarafından malnütrisyon için tanısal bir kriter olarak önerilen hipoalbüminemi ile SGD’ nın hastaya ait biyodemografik özelliklerinin karşılaştırılarak aralarında fark olup olmadığının belirlenmesi amaçlanmıştır.
Materyal ve Metot: Kesitsel tipte yapılan bu çalışma Kars ve
Ardahan da kamuya ait 4 hemodiyaliz merkezinde tedavi sürdüren
191 hastanın verilerinin analizi ile yapılmıştır. Hastalar SGD skoru ve
albümin düzeyine göre iki ayrı grup olarak analiz edildi. Bağımlı değişkeni SGD olan grup nutrisyonel durumuna göre iyi olan ve iyi olmayan
(SGD skor: 1–14 ve 15–49) olarak ikiye bölünürken, bağımlı değişkeni
albümin olan grup (albümin düzeyi: 3,8 g/dl’den düşük ve 3,8 g/dl ve
üzeri olarak) ikiye bölündü. Hastanın yaşı, diyaliz süresi, vasküler erişim yolu, vücut kitle indexi, diyaliz yeterliliği, C-reaktif protein düzeyi,
hemoglobin düzeyi, diabetes mellitus varlığı gibi özellikleri ise bağımsız değişkenler olarak belirlenerek gruplar karşılaştırıldı.
Bulgular: Bu araştırmadaki 191 hastanın sonuçları analiz edildiğinde; nutrisyonel durumu iyi olmayanların oranı %30,9, albümin
düzeyi <3,8 g/dl olanlar %51,3, kadınların oranı %40,8, yaşı 65 ve
üzeri olanlar %51,3, beş yıldan fazla zamandır hemodiyaliz tedavisi
sürdürenlerin oranı %40,8, Vücut kitle indeksi cut-off 23’den aşağı
olanların oranı %43,5, hedef Kt/V düzeyinin altında olanların oranı
%22,5 idi. SGD skoruna göre değerlendirilen hastaların hiç birinde bağımsız değişkenler ile istatiksel olarak anlamlı fark yok iken,
objektif bir kriter olan serum albümin düzeyi ile hastanın cinsiyeti,
Kt/V’si, anemisi ve serum C-reaktif proteini ve vasküler erişim yolu
ile istatiksel olarak anlamlı fark vardı.
Sonuç: Hemodiyaliz hastalarının nutrisyonel durumunu değerlendirmede objektif klinik parametreler SGD’dan daha etkili bir
belirteçtir.
Anahtar Kelimeler
subjektif global değerlendirme; hemodiyaliz hastalarında hipoalbüminemi; malnütrisyon
Kaynakça
- 1. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008;73(4):391–98. 2. Fiedler R, Jehle PM, Osten B, Dorligschaw O, Girndt M. Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance. Nephrology Dialysis Transplantation 2009;24:3812–17. 3. Cooper BA, Bartlett LH, Aslani A, Allen BJ, Ibels LS, Pollock CA. Validity of subjective global assessment as a nutritional marker in end-stage renal disease. Am J Kidney Dis 2002;40(1):126–32. 4. Enia G, Sicuso C, Alati G, Zoccali C. Subjective global assessment of nutrition in dialysis patients. Nephrology Dialysis Transplantation 1993;8(10):1094–98. 5. Canada-USA Peritoneal Dialysis Study Group. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol 1996;7(2):198–207. 6. Fouque D, Vennegoor M, Wee PT, Wanner C, Basci A, Canaud B, et al. EBPG guideline on nutrition. Nephrology Dialysis Transplantation 2007;22(2): ii45-ii87. 7. Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, et al. KDOQI clinical practice guideline for hemodialysis adequacy:2015 update. Am J Kidney Dis 2015;66(5):884–930. 8. Kovesdy C, Regidor DL, Mehrotra R, Jing J, McAllister CJ, Greenland S, et al. Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol 2007;2:999–1007. 9. Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKDMBD) Guideline Update: what’s changed and why it matters. Kidney international 2017;92(1):26–36. 10. Steiber AL, Kalantar-Zadeh K, Secker D, McCarthy M, Sehgal A, McCann L. Subjective Global Assessment in chronic kidney disease: a review. J Ren Nutr 2004;14(4):191–200. 11. Fiedler R, Jehle PM, Osten B, Dorligschaw O, Girndt M. Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance. Nephrology Dialysis Transplantation 2009;24:3812–17. 12. Kalantar-Zadeh K, Block G, McAllister CJ, Humphreys MH, Kopple JD. Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr 2004;80(2):299–307. 13. Kaysen GA, Dubin JA, Müller HG, Mitch WE, Rosales LM, Levin NW. Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients. Kidney international 2002;61(6):2240–49. 14. Goldstein SL, Ikizler TA, Zappitelli M, Silverstein DM, Ayus JC. Non-infected hemodialysis catheters are associated with increased inflammation compared to arteriovenous fistulas. Kidney Int 2009;76(10):1063–69. 15. Fouque D, Pelletier S, Guebre-Egziabher F. Have recommended protein and phosphate intake recently changed in maintenance hemodialysis?. J Ren Nutr 2011;21(1):35–38. 16. Kimata N, Karaboyas A, Bieber BA, Pisoni RL, Morgenstern H, Gillespie BW, et al. Gender, low Kt/V, and mortality in Japanese hemodialysis patients: opportunities for improvement through modifiable practices. Hemodial Int 2014;18(3):596–606. 17. Qureshi AR, Alvestrand A, Danielsson A, Divino-Filho JC, Gutierrez A, Lindholm B, et al. Factors predicting malnutrition in hemodialysis patients: a cross-sectional study. Kidney international 1998;53(3):773–82. 18. Kadiri MEMB, Nechba RB, Oualim Z. Factors predicting malnutrition in hemodialysis patients. Saudi J Kidney Dis Transpl 2011;22(4):695–704. 19. Stoian I, Manolescu B, Atanasiu V, Lupescu O, Buşu C. IL-6- STAT-3-hepcidin: linking inflammation to the iron metabolism. Rom J Intern Med 2007;45(3):305–09. 20. Kalantar-Zadeh K, Rodriguez RA, Humphreys MH. Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients. Nephrology Dialysis Transplantation 2004;19(1):141–49
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Ağustos 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 8 Sayı: 2 |
