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Initiation of planned and unplanned peritonal dialysis: clinical and nutritional aspects

Abstract

Patients with chronic kidney disease (CKD) in non-dialytic phase who needs to start dialysis are submitted to metabolic and hemodynamic stresses. There is also hypercatabolism related to dialytic treatment, inflammation, increased oxidative stress, overhidratyon, loss of nutrients and proteins in the dialysate, uremia with consequent reduction of appetite and acidosis with possibility of degradation of muscle mass. Thus, these patients are vulnerable and have increased risk of energy-protein wasting. In addition, CKD can also have a negative impact on patients' functional capacity, impairing the development of basic activities, as well as leisure, work and social interaction, deteriorating the quality of life. Therefore, it is necessary to interpret the aspects related to body composition, functional capacity and food intake of the patients who are initiating PD in a planned or unplanned and to evaluate if there are differences in the nutritional aspects of these two groups. Thus, it is necessary to interpret the aspects related to body composition, functional capacity and food intake of patients who are starting PD in a planned or unplanned way and to evaluate if there are differences in the nutritional aspects of these two groups, observing the progressively implemented strategies and the differences in the clinical and nutritional aspects, helping in the metabolic and dialytic adequacy. This is a prospective cohort study with CKD patients selected for PD treatment, either unplanned renal replacement therapy with onset within 72 hours after peritoneal catheter implantation, or planned, with 90 or more days pre-dialysis follow-up, accompanied by Dialysis Unit of the Clinical Hospital of the Botucatu Medical School (HCFMB). Patients with pacemakers, amputees and those with permanent physical limitations that preclude adequate nutritional and functional evaluation, end-stage liver disease, severe heart disease, malignant neoplasms, chronic obstructive pulmonary disease and patients using glucocorticoids will be excluded. Patients who meet the criteria will be invited to participate in the study after the passage of a PD catheter. Those who agree to participate will be provided with the necessary information and scheduled when the clinical data will be collected (age, gender, dialysis time, presence of comorbidities, underlying disease, PD modality, peritoneal membrane transport, physical activity), anthropometric (weight, height, body mass index calculation, waist calf and arm circumference, triceps skinfold and arm muscle circumference calculation) and bioimpedance (uni and multifrequency), evaluation of handgrip strength, functional capacity and collection of laboratory tests (interleukin 6 (IL-6), tumor necrosis factor (TNF-alpha), leptin and pro-hormone natriuretic peptide type B (pro-BNP)). The first evaluation will be done within 30 days after the beginning of PD (T0), the second after six months (T1) and the third after 12 months (T2). At T1 a protocol will be applied to evaluate only body composition. Clinical outcomes, such as hospitalizations, infections related or not to PD, dialysis failure and death will be identified from the time of inclusion until twelve months after. (AU)

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VEICULO: TITULO (DATA)
VEICULO: TITULO (DATA)