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Coronary heart disease is the main cause of death in hemodialysis (HD). In turn, the disease generates deterioration of the nutritional status and inflammation, which promotes a low caloric-protein intake, evidenced by changes in anthropometric and biochemical parameters.
This work is aimed at evaluating nutritional malnutrition among diabetic and non-diabetic patients in an Italian hemodialysis center and the consequence of years on dialysis on cardiometabolic parameters.
Cross-sectional study of 60 subjects undergoing chronic hemodialysis (diabetics n=18; non-diabetics n=42 with a mean age of 73.1 ± 11.4 and 64.3 ± 18.5, respectively; 35 male and 25 female). We measured nutritional status indicators (Brachial Muscle Area (AMB), Brachial Fat Area (AGB), Muscle Tissue Index (LTI), Fat Tissue Index (FTI)), biochemical parameters of nutritional implication (transferrin, vitamins B9, B12 and D, bicarbonate, creatinine and albumin), Inflammatory status (CRP, ferritin,) vascular access, residual diuresis, years of dialysis, KT/v), cardiometabolic status (lipid profile, years of dialysis, glycemia and Ca/P ratio). Descriptive statistics were used to characterize the sample, T student in the comparison of groups (diabetes vs non-diabetics) and Pearson's correlation to evaluate the dependence between variables. Statistical analyzes were analyzed with SPSS version 11.0 and a p value <0.05 was considered to establish statistical significance.
A significant increase in FTI was observed in diabetic patients (12,6 ± 5,0) compared to non-diabetic (9,1 ± 5,5) (p=0.03). The more the years on HD, the less the muscle mass (AMB) (p=0.02), the greater the inflammation measured by PCR (p=0.01) and the lower the levels of pre-dialysis uremia (p=0.02) in both diabetics and non-diabetics. Regarding the indicators of nutritional implication, no significant differences were observed between the two groups.
The nutritional status of patients with diabetic kidney disease is altered, both by an excess of adipose tissue, and by a decrease in lean mass, associated with HD protein wasting. Inflammation, as a consequence of malnutrition and years of dialysis, leads to a lower protein intake, reflected by the pre Bun. ¿Could excess adipose tissue then be generating a greater degree of inflammation, exacerbating the clinical situation?