Parámetros bioquímicos y adherencia a la dieta en diabéticos tipo 2 en hemodiálisis

Parámetros bioquímicos y adherencia a la dieta en diabéticos tipo 2 en hemodiálisis

Contenido principal del artículo

Patricio Salazar Luna
Hazel Anderson Vásquez

Resumen

Introducción: El incumplimiento de la dieta y la ingesta de líquidos del paciente en hemodiálisis pueden provocar la acumulación de metabolitos tóxicos en la sangre, lo que provoca una mayor morbilidad y muerte prematura. Objetivo: determinar los parámetros bioquímicos y la adherencia a la dieta en los pacientes con diabetes tipo 2 en hemodiálisis que asisten a la unidad de diálisis del Hospital General IESS Riobamba.  Métodos: se realizó una investigación de enfoque cuantitativo, prospectiva, cuasi-experimental de diseño longitudinal en 87 sujetos con nefropatía diabética de ambos sexos con edades entre 40 y 70 años, que estuviesen recibiendo tratamiento de diálisis. Se realizaron mediciones bioquímicas (hematológicas, perfil metabólico y lipídico, albúmina y electrolitos) y se aplicó el cuestionario de no adherencia a dieta y líquidos para hemodiálisis (DDFQ) Resultados: Se encontraron diferencias significativas (p<0,05) en el género masculino en los siguientes parámetros: hemoglobina, creatinina y albumina. Mientras que en las mujeres se encontraron diferencias significativas en la concentración de ácido úrico. En ambos sexos se observaron diferencias significativas en las concentraciones de fosforo y potasio (p<0.05). Alrededor de 80% de los pacientes  manifestó un grado de desviación de 1 a 3 (entre la no desviación y la desviación moderada) a las restricciones de dieta y líquidos Conclusión: se encontró en la mayoría de los pacientes una buena adherencia a las restricciones de dieta y líquidos que guardó relación con los principales parámetros bioquímicos estudiados.

Citas

Bakkal H., Dizdar OS., Erdem S., Kulakoğlu S., Akcakaya B., Katırcılar Y., & Uludag K. (2020). The Relationship Between Hand Grip Strength and Nutritional Status Determined by Malnutrition Inflammation Score and Biochemical Parameters in Hemodialysis Patients. J Ren Nutr, 30(6):548-555. https://doi: 10.1053/j.jrn.2020.01.026.

Beerendrakumar N., Ramamoorthy L., & Haridasan S. (2018). Dietary and Fluid Regime Adherence in Chronic Kidney Disease Patients. J Caring Sci, 7(1):17-20. https://doi: 10.15171/jcs.2018.003.

Cao M, Zheng S., Zhang W., & Hu G. (2023). Progress in the study of nutritional status and selenium in dialysis patients. Ann Med, 55(1):2197296. https://doi: 10.1080/07853890.2023.2197296.

Cui L., Zhang L., Li J., Li Y., Hao X., Xu Y., & Li C. (2024). Correlation between ultrafiltration rate and hemoglobin level and erythropoietin response in hemodialysis patients. Ren Fail, 46(1):2296609. https://doi: 10.1080/0886022X.2023.2296609.

Demir, S., Nawroth, P. P., Herzig, S., & Ekim Üstünel, B. (2021). Emerging Targets in Type 2 Diabetes and Diabetic Complications. Advanced science (Weinheim, Baden-Wurttemberg, Germany), 8(18), e2100275. https://doi.org/10.1002/advs.202100275.

Efe, D., & Kocaöz, S. (2015). Adherence to diet and fluid restriction of individuals on hemodialysis treatment and affecting factors in Turkey. Japan journal of nursing science : JJNS, 12(2), 113–123. https://doi.org/10.1111/jjns.12055

Gama-Axelsson, T., Heimbürger, O., Stenvinkel, P., Bárány, P., Lindholm, B., & Qureshi, A. R. (2012). Serum albumin as predictor of nutritional status in patients with ESRD. Clinical journal of the American Society of Nephrology : CJASN, 7(9), 1446–1453. https://doi.org/10.2215/CJN.10251011

García Valderrama, F. W., Fajardo, C., Guevara, R., Gonzáles Pérez, V., & Hurtado, A. (2002). Mala adherencia a la dieta en hemodiálisis: papel de los síntomas ansiosos y depresivos [Poor adherence to diet in hemodialysis: role of anxiety and depression symptoms]. Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia, 22(3), 244–252.

Ghaderian, S. B., Hayati, F., Shayanpour, S., & Beladi Mousavi, S. S. (2015). Diabetes and end-stage renal disease; a review article on new concepts. Journal of renal injury prevention, 4(2), 28–33. https://doi.org/10.12861/jrip.2015.07

Gheith, O., Farouk, N., Nampoory, N., Halim, M. A., & Al-Otaibi, T. (2015). Diabetic kidney disease: world wide difference of prevalence and risk factors. Journal of nephropharmacology, 5(1), 49–56.

Hu, E. A., Coresh, J., Anderson, C. A. M., Appel, L. J., Grams, M. E., Crews, D. C., Mills, K. T., He, J., Scialla, J., Rahman, M., Navaneethan, S. D., Lash, J. P., Ricardo, A. C., Feldman, H. I., Weir, M. R., Shou, H., Rebholz, C. M., & CRIC Study Investigators (2021). Adherence to Healthy Dietary Patterns and Risk of CKD Progression and All-Cause Mortality: Findings From the CRIC (Chronic Renal Insufficiency Cohort) Study. American journal of kidney diseases : the official journal of the National Kidney Foundation, 77(2), 235–244. https://doi.org/10.1053/j.ajkd.2020.04.019

Hu, Y., Liu, J., & Jin, H. (2023). Association between serum uric acid and phase angle in patients with type 2 diabetes mellitus: A cross-sectional study. Frontiers in endocrinology, 14, 1124565. https://doi.org/10.3389/fendo.2023.1124565

Iborra-Moltó, C., López-Roig, S., & Pastor-Mira, M.deL. (2012). Prevalence of adherence to fluid restriction in kidney patients in haemodialysis: objective indicator and perceived compliance. Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia, 32(4), 477–485. https://doi.org/10.3265/Nefrologia.pre2012.Feb.11236

Ikizler, T. A., Cano, N. J., Franch, H., Fouque, D., Himmelfarb, J., Kalantar-Zadeh, K., Kuhlmann, M. K., Stenvinkel, P., TerWee, P., Teta, D., Wang, A. Y., Wanner, C., & International Society of Renal Nutrition and Metabolism (2013). Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney international, 84(6), 1096–1107. https://doi.org/10.1038/ki.2013.147

Kalantar-Zadeh, K., Streja, E., Kovesdy, C. P., Oreopoulos, A., Noori, N., Jing, J., Nissenson, A. R., Krishnan, M., Kopple, J. D., Mehrotra, R., & Anker, S. D. (2010). The obesity paradox and mortality associated with surrogates of body size and muscle mass in patients receiving hemodialysis. Mayo Clinic proceedings, 85(11), 991–1001. https://doi.org/10.4065/mcp.2010.0336

Khan, M. A. B., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Al Kaabi, J. (2020). Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends. Journal of epidemiology and global health, 10(1), 107–111. https://doi.org/10.2991/jegh.k.191028.001

Khanna, D., Fitzgerald, J. D., Khanna, P. P., Bae, S., Singh, M. K., Neogi, T., Pillinger, M. H., Merill, J., Lee, S., Prakash, S., Kaldas, M., Gogia, M., Perez-Ruiz, F., Taylor, W., Lioté, F., Choi, H., Singh, J. A., Dalbeth, N., Kaplan, S., Niyyar, V., … American College of Rheumatology (2012). 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis care & research, 64(10), 1431–1446. https://doi.org/10.1002/acr.21772

Kovesdy, C. P., & Kalantar-Zadeh, K. (2012). Accuracy and limitations of the diagnosis of malnutrition in dialysis patients. Seminars in dialysis, 25(4), 423–427. https://doi.org/10.1111/j.1525-139X.2012.01097.x

Kugler, C., Vlaminck, H., Haverich, A., & Maes, B. (2005). Nonadherence with diet and fluid restrictions among adults having hemodialysis. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing, 37(1), 25–29. https://doi.org/10.1111/j.1547-5069.2005.00009.x

Leggat J. E., Jr (2005). Adherence with dialysis: a focus on mortality risk. Seminars in dialysis, 18(2), 137–141. https://doi.org/10.1111/j.1525-139X.2005.18212.x

Li, X., Qureshi, A. R., Suliman, M. E., Heimburger, O., Barany, P., Stenvinkel, P., & Lindholm, B. (2023). Interleukin-6-to-Albumin Ratio as a Superior Predictor of Mortality in End-Stage Kidney Disease Patients. American journal of nephrology, 54(7-8), 268–274. https://doi.org/10.1159/000531191

Luo, D., Luo, Y., Zou, Y., Xu, Y., Fu, B., Yang, D., Yang, J., Xu, C., Ling, S., Li, S., & Qi, A. (2021). Non-high-density lipoprotein cholesterol may predict the cardio-cerebrovascular risk in patients on maintenance hemodialysis. Lipids in health and disease, 20(1), 159. https://doi.org/10.1186/s12944-021-01546-1

Mikolasevic, I., Žutelija, M., Mavrinac, V., & Orlic, L. (2017). Dyslipidemia in patients with chronic kidney disease: etiology and management. International journal of nephrology and renovascular disease, 10, 35–45. https://doi.org/10.2147/IJNRD.S101808

Park, C., Obi, Y., Streja, E., Rhee, C. M., Catabay, C. J., Vaziri, N. D., Kovesdy, C. P., & Kalantar-Zadeh, K. (2017). Serum uric acid, protein intake and mortality in hemodialysis patients. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 32(10), 1750–1757. https://doi.org/10.1093/ndt/gfw419

Patel, S. S., Molnar, M. Z., Tayek, J. A., Ix, J. H., Noori, N., Benner, D., Heymsfield, S., Kopple, J. D., Kovesdy, C. P., & Kalantar-Zadeh, K. (2013). Serum creatinine as a marker of muscle mass in chronic kidney disease: results of a cross-sectional study and review of literature. Journal of cachexia, sarcopenia and muscle, 4(1), 19–29. https://doi.org/10.1007/s13539-012-0079-1

Peng, H., Aoieong, C., Tou, T., Tsai, T., & Wu, J. (2021). Clinical assessment of nutritional status using the modified quantified subjective global assessment and anthropometric and biochemical parameters in patients undergoing hemodialysis in Macao. The Journal of international medical research, 49(9), 3000605211045517. https://doi.org/10.1177/03000605211045517

Qian, G., Zhu, Y., Tao, S., Li, X., Liu, Z., Bai, Y., & Wang, D. (2022). Increased hemoglobin concentration and related factors in maintenance hemodialysis patients in Anhui, China. Medicine, 101(46), e31397. https://doi.org/10.1097/MD.0000000000031397

Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., Colagiuri, S., Guariguata, L., Motala, A. A., Ogurtsova, K., Shaw, J. E., Bright, D., Williams, R., & IDF Diabetes Atlas Committee (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes research and clinical practice, 157, 107843. https://doi.org/10.1016/j.diabres.2019.107843

Saran, R., Robinson, B., Abbott, K. C., Bragg-Gresham, J., Chen, X., Gipson, D., Gu, H., Hirth, R. A., Hutton, D., Jin, Y., Kapke, A., Kurtz, V., Li, Y., McCullough, K., Modi, Z., Morgenstern, H., Mukhopadhyay, P., Pearson, J., Pisoni, R., Repeck, K., … Shahinian, V. (2020). US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States. American journal of kidney diseases : the official journal of the National Kidney Foundation, 75(1 Suppl 1), A6–A7. https://doi.org/10.1053/j.ajkd.2019.09.003

Sohrabi, Z., Eftekhari, M. H., Eskandari, M. H., Rezaeianzadeh, A., & Sagheb, M. M. (2015). Malnutrition-inflammation score and quality of life in hemodialysis patients: is there any correlation?. Nephro-urology monthly, 7(3), e27445. https://doi.org/10.5812/numonthly.7(3)2015.27445

St-Jules, D. E., Goldfarb, D. S., Pompeii, M. L., Liebman, S. E., & Sherman, R. A. (2018). Assessment and misassessment of potassium, phosphorus, and protein in the hemodialysis diet. Seminars in dialysis, 31(5), 479–486. https://doi.org/10.1111/sdi.12713

Valente, A., Caetano, C., Oliveira, T., & Garagarza, C. (2019). Evaluating haemodialysis patient's nutritional status: Body mass index or body cell mass index?. Nephrology (Carlton, Vic.), 24(9), 967–974. https://doi.org/10.1111/nep.13527

Vlaminck, H., Maes, B., Jacobs, A., Reyntjens, S., & Evers, G. (2001). The dialysis diet and fluid non-adherence questionnaire: validity testing of a self-report instrument for clinical practice. Journal of clinical nursing, 10(5), 707–715. https://doi.org/10.1046/j.1365-2702.2001.00537.x

Walther, C. P., Carter, C. W., Low, C. L., Williams, P., Rifkin, D. E., Steiner, R. W., & Ix, J. H. (2012). Interdialytic creatinine change versus predialysis creatinine as indicators of nutritional status in maintenance hemodialysis. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association, 27(2), 771–776. https://doi.org/10.1093/ndt/gfr389

World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053.