Kronik böbrek yetmezliği hastalarında kırılganlığın nütrisyonel parametrelerle ilişkisi
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Dosyalar
Tarih
2016
Yazarlar
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Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kronik böbrek hastalarında (KBH) kırılganlık bir çok çalışmada değerlendirilmiştir. Fakat kırılganlığa etki eden malnütrisyon durumları üzerinde yeteri kadar çalışma bulunmamaktadır. Bu çalışma kırılganlık ile nütrisyonel parametreler arasındaki ilişkiyi göstermeyi amaçlamıştır. Yöntem: Kesitsel nitelikteki bu çalışmaya 50 yaş üzerindeki KBH olan 100 hasta alındı. Kırılganlık, Türkiye'de geçerliliği ve güvenirliği kanıtlanmış Edmonton Kırılganlık Skalası (EKS) ve pek çok hasta popülasyonunda yüksek geçerlilik ve güvenirliliği olan ve Türk popülasyonunda da daha önce kullanılmış olan Fried's Kırılganlık Skalası (FKS) ile değerlendirildi. Hastaların rutin poliklinik muayeneleri sırasında antropometrik ölçümleri (boy, kilo, orta kol kas çevresi, baldır çevresi, kaliper ile deri kıvrım kalınlıkları) alındı. Ayrıca, dinapeni için dinamometre ile el kavrama gücü ölçümü yapıldı. Hastaların beslenme durumları, rutin laboratuar testlerinden elde edilen parametrelerin yanı sıra (serum albümin, kolesterol vb.), Türkiye'de geçerliliği ve güvenilirliği kanıtlanan Mini Nutrisyonel Değerlendirme (MND) testi ile değerlendirildi. Bulgular: Çalışmaya katılan 100 hastanın 41'i kadın, 59'u erkek idi. Yaş ortalamaları 65,3±9,3 idi. Mini Nütrisyonel Değerlendirme 'ye göre malnütrisyon görülen hasta sayısı 22, malnütrisyon riskli hasta sayısı 63 saptandı. Edmonton kırılganlık skalasına göre hastaların 4'ü (%4) kırılgan değil, 11'i (%11) görünüşte incinebilir, 25'i (%25) hafif kırılgan, 21'i (%21) orta kırılgan ,39'u (%39) şiddetli kırılgan idi. Fried's kırılganlık skalasına göre hastaların 6'sı (%6) kırılgan değil, 30'u (%30) prekırılgan, 64'ü (%64) kırılgan idi. Edmonton kırılganlık skalasına göre hastalar gruplandırıldıktan sonra hastaların laboratuar parametreleri ve antropometrik ölçümleri karşılaştırıldı. Tüm grupta serum albümin (p:0,003), total kolesterol (p:0,019), LDL (p:0,025), demir (p:0,008) ve biceps DKK (p:0,08), triceps DKK (p:0.047), kas gücü (p:<0,0001) anlamlı olarak farklı olduğu tespit edildi. Fried's kırılganlık skalasına göre hastalar gruplandırıldıktan sonra hastaların laboratuar parametreleri ve antropometrik ölçümleri karşılaştırıldı. Tüm grupta hemoglobin (p:0,004), üre (p<0,0001), serum kreatinin (p:0,032), potasyum (p:0,003), kalsiyum (p:0,041), serum albümin (p:0,034), ürik asit (p:0,028), vitamin D (p:0,018), GFH (p:0,012) ve orta kol çevresi (p:0,009), biceps DKK (p:0,06), triceps DKK (p:0,011) ölçümlerinde anlamlı olarak fark olduğu tespit edildi. Edmonton kırılganlık skalası ve Fried's kırılganlık skalası ile bağımsız ilişkili faktörlerin belirlenmesi için yapılan çoklu değişkenli lineer regresyon analizinde hastaların yaş, cinsiyet, MND, hemoglobin, trigliserid, albumin, transferrin, diyabetes mellitus, GFH(ml/dk/1.73 m2), HCO3 parametreleri değerlendirildi. Edmonton kırılganlık skalası ile yaş, MND, serum albümin, GFH arasında diğer faktörlerden bağımsız ilişki saptandı. Fried's kırılganlık skalası ile yaş, MND ve GFH arasında diğer faktörlerden bağımsız ilişkili idi. Sonuç: Bu çalışma KBH olan hastalarda kırılganlık ile nütrisyonel parametrelerin ilişkisini araştırıldığı literatürdeki ilk çalışmadır. Sonuç olarak, KBH olan hastalarda kırılganlık ve malnütrisyon, tüm diğer faktörlerden bağımsız bir şekilde ilişkilidir. Kronik böbrek hastalarında erken evrelerden itibaren malnütrisyon taramalarının yapılması ve uygun hastaların tedavi edilmesi, gelişmesi muhtemel kırılganlığın önlenebileceği düşündürmektedir. Kronik böbrek hastalarında malnütrisyonun tedavi edilmesi ve kas gücünü arttıran egzersiz yapmak, tanımlanmamış medikal durumları saptayarak erken kapsamlı değerlendirme yapmak, özellikle yatış sırasında nütrisyonel destek vermek, ilaçlarını düzenleyerek gereksiz ilaç alınımından kaçınmak, erken mobilizasyon yapmak ve sosyal koşulların iyileştirilmesini sağlamak gibi girişimlerin KBH olanlarda kırılganlık üzerindeki ilişkisinin araştırılacağı prospektif çalışmalara ihtiyaç vardır.
Purpose: A lot of studies have been conducted to our way to evaluate frailty in patients with chronic kidney disease (CKD), but there aren't enough studies on the effects of malnutrition on frailty. This study aims to reveal the relationship between frailty and nutritional parameters. Method: This study has been conducted on 100 patients with CKD over 50 years in a cross-section of way. frailty is determined with the Edmonton frailty scale, which is proved validity and reliability in Turkey and with the Fried's frailty scale, which has a high validity and reliability in large patient populations and which has been used on populations of Turkish patients. During the routine examination of the patients in the clinic, anthropometric measurements (height, weight, mid-arm muscle circumference, calf circumference) were taken from the patients. Besides, hand-grasp measurement was conducted for dinapeny with dynometer. Nutritional conditions of the patients as well as the parameters obtained from routine laboratory tests (serum albumin, cholesterol, etc.) were assessed with the Mini Nutritional Assessment (MNA), whose reliability and validity are proven in Turkey. Findings: Of 100 patients participating in the study, 41 were female and 59 were male. The average age was 65,3±9,3 . According to the MNA, the number of the patients on whom malnutrition was observed was 22, and the number of the patients at risk from malnutrition was 63. According to the Edmonton frailty scale, 4 of the patients (4%) weren't frail, 11 (11%) seemed frail, 25 (25%) were slightly frail, 21 (21%) were moderately frail, 39 (39%) were highly frail. According to the Fried's frailty scale, six of the patients (6%) were not frail, 30 (30%) were prefrail and 64 (64%) were frail. The laboratory parameters and anthropometric measurements of the patients were compared after the patients were grouped according to the Edmonton frailty scale. Serum albumin (p:0,003), total cholesterol(p:0,019), LDL(p:0,025), iron (p:0,008) and biceps DKK (p:0,08), triceps DKK (p:0.047), muscular strength (p:<0,0001) were found to be significantly different in the whole group. The laboratory parameters and anthropometric measurements of the patients were compared after the patients were grouped according to the Fried's frailty test. Significant differences were found as regards hemoglobin(p:0,004), urea(p<0,0001), serum keratinin(p:0,032), potassium(p:0,003), calcium(p:0,041), serum albumin(p:0,034), uric acid(p:0,028), vitamin D(p:0,018), GFH(p:0,012) and mid-arm circumference(p:0,009), biceps DKK (p:0,06), triceps measurements DKK (p:0,011) in the whole group. In the multivariable linear regression analysis conducted to identify independent related factors with the Edmonton frailty scale and with the Fried's frailty test, the parameters of age, gender, MNA, hemoglobin, triglycerides, albumin, transferrin, diabetes mellitus, GFH (ml/min./1.73 m2), and HCO3 were evaluated. A relationship independent from the other factors was detected between age, MNA, serum albumin and GFH with the Edmonton frailty scale. The age, MNA and GFH were related independently from the other factors on Fried's frailty test. Results: This study is the first in literature to research the relationship between frailty in patients which CKD and nutritional parameters. As a result, frailty and malnutrition are related independently from all the factors in patients with CKD. The fragility likely to develop in patients with CKD frailtycould be prevented with malnutrition scans from early stages and likely candidates of CKD could be treated. Prospective studies are required to study the relationship between frailty and treating malnutrition in patients with CKD, doing exercise which improves muscular strength, detecting undetected medical conditions, making early comprehensive assessment, giving nutritional supplements, especially during the hospitalization, avoiding unnecessary medicine intake by arranging medicine and improving social conditions of the patients with CKD.
Purpose: A lot of studies have been conducted to our way to evaluate frailty in patients with chronic kidney disease (CKD), but there aren't enough studies on the effects of malnutrition on frailty. This study aims to reveal the relationship between frailty and nutritional parameters. Method: This study has been conducted on 100 patients with CKD over 50 years in a cross-section of way. frailty is determined with the Edmonton frailty scale, which is proved validity and reliability in Turkey and with the Fried's frailty scale, which has a high validity and reliability in large patient populations and which has been used on populations of Turkish patients. During the routine examination of the patients in the clinic, anthropometric measurements (height, weight, mid-arm muscle circumference, calf circumference) were taken from the patients. Besides, hand-grasp measurement was conducted for dinapeny with dynometer. Nutritional conditions of the patients as well as the parameters obtained from routine laboratory tests (serum albumin, cholesterol, etc.) were assessed with the Mini Nutritional Assessment (MNA), whose reliability and validity are proven in Turkey. Findings: Of 100 patients participating in the study, 41 were female and 59 were male. The average age was 65,3±9,3 . According to the MNA, the number of the patients on whom malnutrition was observed was 22, and the number of the patients at risk from malnutrition was 63. According to the Edmonton frailty scale, 4 of the patients (4%) weren't frail, 11 (11%) seemed frail, 25 (25%) were slightly frail, 21 (21%) were moderately frail, 39 (39%) were highly frail. According to the Fried's frailty scale, six of the patients (6%) were not frail, 30 (30%) were prefrail and 64 (64%) were frail. The laboratory parameters and anthropometric measurements of the patients were compared after the patients were grouped according to the Edmonton frailty scale. Serum albumin (p:0,003), total cholesterol(p:0,019), LDL(p:0,025), iron (p:0,008) and biceps DKK (p:0,08), triceps DKK (p:0.047), muscular strength (p:<0,0001) were found to be significantly different in the whole group. The laboratory parameters and anthropometric measurements of the patients were compared after the patients were grouped according to the Fried's frailty test. Significant differences were found as regards hemoglobin(p:0,004), urea(p<0,0001), serum keratinin(p:0,032), potassium(p:0,003), calcium(p:0,041), serum albumin(p:0,034), uric acid(p:0,028), vitamin D(p:0,018), GFH(p:0,012) and mid-arm circumference(p:0,009), biceps DKK (p:0,06), triceps measurements DKK (p:0,011) in the whole group. In the multivariable linear regression analysis conducted to identify independent related factors with the Edmonton frailty scale and with the Fried's frailty test, the parameters of age, gender, MNA, hemoglobin, triglycerides, albumin, transferrin, diabetes mellitus, GFH (ml/min./1.73 m2), and HCO3 were evaluated. A relationship independent from the other factors was detected between age, MNA, serum albumin and GFH with the Edmonton frailty scale. The age, MNA and GFH were related independently from the other factors on Fried's frailty test. Results: This study is the first in literature to research the relationship between frailty in patients which CKD and nutritional parameters. As a result, frailty and malnutrition are related independently from all the factors in patients with CKD. The fragility likely to develop in patients with CKD frailtycould be prevented with malnutrition scans from early stages and likely candidates of CKD could be treated. Prospective studies are required to study the relationship between frailty and treating malnutrition in patients with CKD, doing exercise which improves muscular strength, detecting undetected medical conditions, making early comprehensive assessment, giving nutritional supplements, especially during the hospitalization, avoiding unnecessary medicine intake by arranging medicine and improving social conditions of the patients with CKD.
Açıklama
Anahtar Kelimeler
Malnütrisyon, Kronik böbrek hastalığı, Kırılganlık, Deri kıvrım kalınlıkları, Malnutrition, Chronic kidney disease, Frailty, Skinfold thickness
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Evcen, R. (2016). Kronik böbrek yetmezliği hastalarında kırılganlığın nütrisyonel parametrelerle ilişkisi. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
