Início de diálise peritoneal planejado e não planejado: aspectos clínicos e nutricionais
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Data
2023-05-19
Autores
Silva, Maryanne Zilli Canedo da
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Universidade Estadual Paulista (Unesp)
Resumo
INTRODUÇÃO: O início da diálise peritoneal (DP) pode ocorrer com ou sem planejamento prévio. A comparação de marcadores nutricionais entre o modo de início, planejado ou não planejado ainda não foi explorada. Portanto, o objetivo desse trabalho é investigar se existem diferenças nos parâmetros clínicos e nutricionais, bem como desfechos clínicos no decorrer de 12 meses entre o modo de início de DP planejado e não planejado. MÉTODOS: Estudo tipo coorte prospectivo com pacientes adultos incidentes em DP com modo não planejado (início da diálise até 72 horas após o implante do cateter peritoneal) e planejado (seguimento pré-diálise ≥ 90 dias). Todos os participantes tiveram seu estado nutricional avaliado por meio de medidas antropométricas, bioimpedância multifrequencial, avaliação do apetite, ingestão alimentar, equivalente proteico do aparecimento de nitrogênio (PNA), força de preensão manual e Malnutrition Inflammation Score (MIS). Além disso, foram avaliados dados clínicos, nível de atividade física, performance física e marcadores laboratoriais. As avaliações ocorreram em até trinta dias após início da DP (T0), após seis (T1) e 12 meses (T2). Os desfechos (falência da técnica, hospitalização, infecção relacionada e não relacionada a DP e óbito) foram acompanhados durante esse período. RESULTADOS: Foram incluídos 47 pacientes, 61,7% (n=29) iniciaram DP de modo não planejado. Destes, 39 pacientes realizaram a avaliação no T1 e 34 finalizaram a participação no estudo (T2). Pacientes que iniciaram DP de modo não planejado apresentaram níveis mais baixos de hemoglobina e albumina, níveis mais altos de ureia, potássio, glicemia e hemoglobina glicada, bem como menor circunferência da panturrilha e maior MIS, PNA e tempo no teste de marcha em comparação ao grupo planejado. Durante os 12 meses de seguimento, os grupos passaram a ter valores similares com relação às variáveis clínicas e nutricionais que apresentaram diferenças em T0. Na análise de comparação entre tempos e grupos, houve significância estatística em relação ao peso, índice de massa corporal, circunferência abdominal, circunferência da panturrilha, níveis séricos de ureia e hemoglobina glicada, classificação do apetite, MIS e PNA (p-valor da interação <0,05). Não foram encontradas diferenças entre os grupos com relação aos marcadores inflamatórios e estado volêmico no momento inicial e final, assim como não houve diferenças entre os desfechos avaliados. CONCLUSÕES: Foram encontradas diferenças entre os grupos planejado e não planejado em T0 com relação aos parâmetros clínicos e nutricionais nos pacientes de início não planejado. Ao longo do seguimento, foi observada semelhança entre os grupos com relação as variáveis clínicas e nutricionais que apresentavam diferença em T0. Não houve diferença entre os grupos em relação aos desfechos clínicos avaliados.
BACKGROUND: The start of peritoneal dialysis (PD) can occur with or without prior planning. The comparison of nutritional markers between the planned and unplanned mode of PD start has not yet been explored. Therefore, the aim of this study is to investigate whether there are differences in clinical and nutritional parameters, as well as clinical outcomes over 12 months, between planned and unplanned PD. METHODS: Prospective cohort study with incident adult patients on unplanned PD (starting dialysis within 72 hours after peritoneal catheter implantation) and planned PD (pre-dialysis follow-up ≥ 90 days). All participants had their nutritional status assessed by anthropometric measurements, multifrequency bioimpedance, appetite assessment, dietary intake, protein nitrogen appearance (PNA), handgrip strength, and Malnutrition Inflammation Score (MIS). In addition, clinical data, physical activity level, physical performance, and laboratory markers were evaluated. The evaluations occurred thirty days after PD start (T0), after six months (T1) and 12 months (T2). Outcomes (technical failure, hospitalization, infection related and unrelated to PD, and death) were observed during this period. RESULTS: 47 patients were included, 61.7% (n=29) started unplanned PD. Of these, 39 patients underwent the evaluation at T1 and 34 completed their participation in the study (T2). Patients who started PD in an unplanned mode presented lower levels of hemoglobin and albumin, higher levels of urea, potassium, glycemia and glycated hemoglobin, as well as, lower calf circumference, higher MIS, PNA and longer time on the gait test compared to the planned group. During 12 months of followup, the groups presented similar values regarding the clinical and nutritional variables that showed differences in T0. In the comparison analysis between times and groups, there was statistical significance in relation to body weight, body mass index, waist circumference, calf circumference, serum urea levels and glycated hemoglobin, appetite, MIS and PNA (interaction p-value <0.05). No differences were found between the groups regarding inflammatory markers and volemic status at T0 and T2, as well as there were no differences between the evaluated outcomes. CONCLUSIONS: Differences were found between the planned and unplanned groups at T0, according to clinical and nutritional parameters in patients with unplanned start. During the follow-up, similarity was observed between the groups regarding the clinical and nutritional variables that were different at T0. No differences were found between the groups regarding the clinical outcomes.
BACKGROUND: The start of peritoneal dialysis (PD) can occur with or without prior planning. The comparison of nutritional markers between the planned and unplanned mode of PD start has not yet been explored. Therefore, the aim of this study is to investigate whether there are differences in clinical and nutritional parameters, as well as clinical outcomes over 12 months, between planned and unplanned PD. METHODS: Prospective cohort study with incident adult patients on unplanned PD (starting dialysis within 72 hours after peritoneal catheter implantation) and planned PD (pre-dialysis follow-up ≥ 90 days). All participants had their nutritional status assessed by anthropometric measurements, multifrequency bioimpedance, appetite assessment, dietary intake, protein nitrogen appearance (PNA), handgrip strength, and Malnutrition Inflammation Score (MIS). In addition, clinical data, physical activity level, physical performance, and laboratory markers were evaluated. The evaluations occurred thirty days after PD start (T0), after six months (T1) and 12 months (T2). Outcomes (technical failure, hospitalization, infection related and unrelated to PD, and death) were observed during this period. RESULTS: 47 patients were included, 61.7% (n=29) started unplanned PD. Of these, 39 patients underwent the evaluation at T1 and 34 completed their participation in the study (T2). Patients who started PD in an unplanned mode presented lower levels of hemoglobin and albumin, higher levels of urea, potassium, glycemia and glycated hemoglobin, as well as, lower calf circumference, higher MIS, PNA and longer time on the gait test compared to the planned group. During 12 months of followup, the groups presented similar values regarding the clinical and nutritional variables that showed differences in T0. In the comparison analysis between times and groups, there was statistical significance in relation to body weight, body mass index, waist circumference, calf circumference, serum urea levels and glycated hemoglobin, appetite, MIS and PNA (interaction p-value <0.05). No differences were found between the groups regarding inflammatory markers and volemic status at T0 and T2, as well as there were no differences between the evaluated outcomes. CONCLUSIONS: Differences were found between the planned and unplanned groups at T0, according to clinical and nutritional parameters in patients with unplanned start. During the follow-up, similarity was observed between the groups regarding the clinical and nutritional variables that were different at T0. No differences were found between the groups regarding the clinical outcomes.
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Palavras-chave
Doença renal crônica, Diálise peritoneal, Início não planejado, Estado nutricional, Composição corporal, Chronic kidney disease, Peritoneal dialysis, Unplanned start, Nutritional status, Body composition