| Abstract | Poznato je kako je kod bolesnika liječenih HD-om poremećaji statusa uhranjenosti i OS-a značajno doprinose ukupnoj i srčano-žilnoj smrtnosti koja je kod ove skupine bolesnika značajno viša nego u općoj populaciji.
Cilj ovog istraživanja je bio istražiti promjenjivost pokazatelja statusa uhranjenosti i OS-a te njihovu međusobnu povezanost tijekom šestomjesečnog praćenja. U istraživanje je uključeno 45 bolesnika, prosječne dobi 70 godina (raspon 60,5-76,5 godina) liječenih HD-om prosječno 27 mjeseci (16-53,5 mjeseci). Mjerenja antropometrijskih i biokemijskih pokazatelja statusa uhranjenosti, analiza sastava tijela sa BIS-om te procjena statusa uhranjenosti standardiziranim upitnicima za bolesnike liječene HD-om provedeni su u tri puta tijekom 6 mjeseci (lipanj, listopad, siječanj). Nadalje, za procjenu OS-a korišteni su testovi oksidativnog oštećenja molekula poput reaktivnih kisikovih metabolita (d-ROMs) i lipidne peroksidacije (TBARS), ali i pokazatelji antioksidativne obrane organizma poput sadržaja tiola na proteinima plazme (TIOLI) i antioksidativni kapacitet plazme (FRAP) te razina vitamina C. Također ispitano je postojanje utjecaja doze dijalize (mjereno sa Kt/V i URR) i doze EPO-a na statusa uhranjenosti i OS. Rezultati su pokazali kako je tijekom šestomjesečnog praćenja došlo do značajnog povišenja pokazatelja masnog tkiva: FTI (p<0,001), FTM (p<0,001) i ATM (p<0,001) uz istovremeno smanjenje pokazatelja koji reflektiraju status uhranjenosti: LTI (p<0,001), LTM (p<0,001) i BCM (p<0,001) te hiperhidraciju (OH) (p=0,004). Pokazatelji masnog tkiva FTI, FTM, ATM pokazali su statistički značajnu pozitivnu korelaciju sa ITM (ρ=0,711, p<0,001; ρ=0,738, p<0,001; ρ= 0,728, p<0,001), obujmom nadlaktice (ρ=0,455, p=0,01; ρ=0,503, p<0,001; ρ=0,503, p<0,001), obujmom struka (ρ=0,571, p<0,01; ρ=0,649, p<0,001; ρ=0,649, p<0,001), obujmom bokova (ρ=0,648, p<0,001; ρ=0,758, p<0,001; ρ=0,752, p<0,001) i WHtR (ρ=0,641, p<0,001; ρ=0,631, p<0,001; ρ=0,624, p<0,001) Analizom biomarkera OS-a utvrđena je značajna varijabilnost d-ROMs-a (p=0,002) i TIOLA (p=0,002). Vrijednost d-ROMs-a je pozitivno korelirala pokazateljima masnog tkiva: FTI (ρ=0,383, p=0,03) i FTM (ρ =0,387, p=0,03), te upalnim pokazateljima poput leukocita (ρ=0,417, p<0,001) i hs-CRP-a (ρ=0,571, p<0,001). Kao značajni biokemijski pokazatelj uhranjenosti prealbumin je pozitivno korelirao s pokazateljima nemasnog tkiva LTI (ρ=-0,434, p=0,01), LTM (ρ=-0,467, p=0,01) i BCM (ρ=-0,475, p=0,01). Pokazatelji doze dijalize: Kt/V i URR negativno su korelirali s pokazateljima koji reflektiraju mišićnu masu: LTM (ρ=-0,444, p=0,01;ρ= -0,486, p=0,005) i BCM (ρ=-0,434, p=0,01; ρ=-0,476, p=0,006). Urađenom multivarijantnom regresijskom analizom obujam bokova se pokazao kao najznačajniji prediktor za d-ROMs (ß = 2.8; 95% CI 0,63 do 5,04; P=0,01), a za TIOLE to je bila vrijednost prealbumina (ß = 263,9; 95% CI 6,8 do 521,1; P=0,04).
Ovo istraživanje pokazalo je kako postoji značajna povezanost između pokazatelja statusa uhranjenosti i biomarkera OS, te kako su pokazatelji statusa uhranjenosti ujedno i značajni prediktori OS-a u bolesnika liječenih HD-om. Također, postoji potencijalni dvosmjeran odnos između biomarkera OS-a i pokazatelja sastava tijela, osobito onih koji reflektiraju masno tkivo. |
| Abstract (english) | It is well known that in HD patients disorders of nutritional status and OS significantly contribute to all-cause and cardiovascular mortality in HD patients which is proven to be significantly higher in this group of patients than in general population.
Aim of this study was to assess variability of markers of nutritional status and biomarkers of OS and their possible interactions during six months follow-up.
Study included 45 patients, 70 years of age (60.5 -76.5 years) with median dialysis duration of 25 months (16-53.5 months). During follow-up we measured three times (June, October and Januar) anthropometric and biochemical parameters of nutritional status, body composition analysis and assessment of nutritional status using MIS and DMS nutritional questionnaire for HD patients. Further, OS analysis was performed by using tests showing oxidative damage like reactive oxygen metabolites (d-ROMs) and products of lipid peroxidation (TBARS) together with tests for assessing antioxidative defence like protein plasma reduced thiol content (THIOLS) and antioxidation capacity of plasma (FRAP) with levels of vitamin C. Also, study assessed influence of dialysis dose (measured with Kt/V and URR) and EPO dose on nutritional status and OS.
Results showed that during follow-up there was a significant increase of body composition markers that reflect adipose tissue: FTI (P<0.001), FTM (P<0.001) and ATM (P<0.001), while simultaneously body composition markers that reflect nutritional status significantly decreased: LTI (P<0.001), LTM (P<0.001) i BCM (P<0.001) as well as overhydration (OH) (P=0.004).
Fat tissue body composition markers FTI, FTM and ATM showed statistically significant positive correlation with BMI (ρ=0.711, P<0.001; ρ=0.738, P<0.001; ρ= 0.728, P<0.001), MUAC (ρ=0.455, P=0.01; ρ=0.503, P<0.001; ρ=0.503, P<0.001), waist circumference (ρ=0.571, P<0.01; ρ=0.649, P<0.001; ρ=0.649, P<0.001), hip circumference (ρ=0.648, P<0.001; ρ=0.758, P<0.001; ρ=0.752, P<0.001) and WHtR (ρ=0.641, P<0.001; ρ=0.631, P<.0.001; ρ=0.624, P<0.001). Additionally significant variations in levels of d-ROMs (P=0.02) and THIOLS (P=0.002) were found. Levels of d-ROMs significantly correlated with FTI (ρ=0.383, P=0.03) and FTM (ρ =0.387, P=0.03), and inflammation markers like leucocytes (ρ=0.417, P<0.001) and hs-CRP levels (ρ=0.571, p<0.001). Significant biochemical marker of nutritional status prealbumin significantly positively correlated with body composition parameters that reflect muscle mass: LTI (ρ=-0.434, P=0.01), LTM (ρ=-0.467, P=0.01) and BCM (ρ=-0.475, P=0.01). Parameters of dialysis dose Kt/V and URR significantly correlated with body composition markers that reflect muscle mass LTM (ρ=-0.444, P=0.01;ρ= -0.486, P=0.005) and BCM (ρ=-0.434, P=0.01; ρ=-0.476, P=0.006). Multivariant regression analysis found that hip circumference was the most significant predictor of d-ROMs levels (ß = 2.8; 95% CI 0.63- 5.04; P=0.01) and prealbumin was the most significant predictor for THIOLS level (ß = 263.9; 95% CI 6.8- 521.1; P=0.04).
In conclusion, this study suggests significant interaction between markers of nutritional status and biomarkers of OS. Furthermore, there is potentially bidirectional relationship between biomarkers of OS and parameters of body composition, especially those parameters that reflect fat tissue. |
