Análise de agrupamento baseado em parâmetros clínicos nutricionais e laboratoriais de pacientes renais crônicos em hemodiálise
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Data
2019-02-28
Autores
Antonio, Karina de Jesus
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A evolução clínica da doença renal crônica está associada a altas taxas de morbidade. As complicações decorrem da progressão da doença renal, levando ao declínio cognitivo, anemia, distúrbios minerais e ósseos, fraturas, riscos nutricionais e aumento da mortalidade cardiovascular e por outras causas. Dentre as alterações nutricionais está a sarcopenia, definida como diminuição global e progressiva da força e massa muscular, com efeitos na função muscular, diminuição da mobilidade e da atividade física. Em diálise, maior atenção merece ser dada para esses fatores, visando prevenir mais complicações. A complexidade da doença renal avançada sugere que sejam buscadas ferramentas que possam avaliar a maior gravidade dos pacientes. Neste contexto, torna-se importante, identificar grupos de pacientes com características semelhantes e considerando o risco de desfechos. Objetivo: Interpretar por análise de agrupamento de parâmetros clínicos e nutricionais, uma população de pacientes prevalentes em hemodiálise, considerando a evolução clínica e com ênfase no diagnóstico de sarcopenia. Metodologia: Estudo de coorte, retrospectivo, descritivo e observacional. Foram identificadas características clínicas, laboratoriais e nutricionais, seguido da investigação de sarcopenia e análise de agrupamento com acompanhamento de desfechos clínicos dos pacientes em hemodiálise. Para diagnóstico de sarcopenia foi realizada avaliação da composição corporal usando bioimpedância unifrequencial e força de preensão manual. Para comparações entre amostra com e sem sarcopenia foi utilizado test t de Student, Mann-Whitney ou Qui quadrado. Método Ward foi utilizado para análise de clusters. Teste de ANOVA, teste de Tukey ou Kruskal Wallis, seguido teste Dunnet foram utilizados para comparações. Para análise de sobrevida usou-se curva de Kaplan-Meir. O nível de significância adotado foi de p<0,05. Resultados: Dos 174 pacientes avaliados, 37,9% foram diagnosticados com sarcopenia. Pacientes com e sem sarcopenia foram diferentes em relação a idade, Kt/V, creatinina, hematócrito, lipoproteína de alta densidade, e todos os aspectos de avaliação antropométrica, massa e força muscular. Os clusters apresentaram diferenças em relação a sexo, idade, Kt/V, creatinina, ureia, albumina, hematócrito, linfócito, 25-hidroxivitamina, fósforo, ferro, bicarbonato, Proteína C reativa, colesterol total, lipoproteína de alta densidade, triglicerídeos, índice de massa corporal, adequação da circunferência do braço e da dobra cutânea tricipital, e aspectos de avaliação de composição corporal e função muscular. Os clusters não apresentaram diferenças em relação a análise de sobrevida por Kaplan-Meier Conclusão: Aspectos clínicos e nutricionais presentes nos cinco clusters deste estudo mostraram características heterogêneas da doença, que podem se relacionar com diferentes desfechos. Sugere-se como alternativa para particularizar o acompanhamento e o tratamento, atuando com maior efetividade nos agrupamentos.
Background: Clinical evolution of chronic kidney disease is associated with high morbidity rates. Complications arise from the progression of renal disease, leading to cognitive decline, anemia, mineral and bone disorders, fractures, nutritional risk and increased cardiovascular and all causes mortality. Among the nutritional changes, sarcopenia, which is defined as a global and progressive reduction of muscle strength and mass, with effects on function muscle, decreases mobility and physical activity. In dialysis, these factors should receive greater attention, in order to prevent further complications. The complexity of advanced kidney disease suggests that tools that assess the severity of patients should be sought. In this context, it is important to identify groups of patients with similar characteristics considering the risk of outcomes. Objective: To analyze clinical and nutritional parameters using cluster analysis of a population of patients on maintenance hemodialysis, considering the clinical evolution with emphasis in sarcopenia diagnosis. Methods: This is a cohort, retrospective, descriptive and observational study. Clinical, laboratory and nutritional characteristics were identified, followed by sarcopenia investigation and cluster analysis, with follow-up of clinical outcomes of patients in maintenance hemodialysis. For sarcopenia diagnosis, body composition evaluation was performed using unifrequencial bioimpedance and handgrip strength. To compare the samples with and without sarcopenia, Student's t-test, Mann-Whitney, or Chi-square were used. Ward method was used for cluster analysis. ANOVA test, Tukey test or Kruskal Wallis, followed by Dunnet test were used for comparisons. Using this cut-off to fit the Kaplan-Meier survival curve. The level of significance was set at p <0.05. Results: 174 patients evaluated, 37.9% were diagnosed with sarcopenia. Patients with and without sarcopenia were different in relation to age, Kt/V, creatinine, hematocrit, high density lipoprotein, and all aspects of anthropometric, mass and muscle strength evaluation. The comparison among the clusters showed differences in sex, age, Kt/V, creatinine, urea, albumin, hematocrit, lymphocyte, 25-hydroxyvitamin D, phosphate, iron, bicarbonate, C-reactive protein, total cholesterol, high density lipoprotein, triglycerides, body mass index, percent standard of mid-arm circumference and triceps skinfold thickness, body composition, and muscle function. Kaplan-Meier not showed relation in outcomes. Conclusion: Clinical and nutritional aspects in the five clusters of this study showed heterogeneous characteristics of the disease, that may be related to different outcomes. This suggests an alternative to particularize the treatment and follow-up, acting with greater effectiveness in the clusters.
Background: Clinical evolution of chronic kidney disease is associated with high morbidity rates. Complications arise from the progression of renal disease, leading to cognitive decline, anemia, mineral and bone disorders, fractures, nutritional risk and increased cardiovascular and all causes mortality. Among the nutritional changes, sarcopenia, which is defined as a global and progressive reduction of muscle strength and mass, with effects on function muscle, decreases mobility and physical activity. In dialysis, these factors should receive greater attention, in order to prevent further complications. The complexity of advanced kidney disease suggests that tools that assess the severity of patients should be sought. In this context, it is important to identify groups of patients with similar characteristics considering the risk of outcomes. Objective: To analyze clinical and nutritional parameters using cluster analysis of a population of patients on maintenance hemodialysis, considering the clinical evolution with emphasis in sarcopenia diagnosis. Methods: This is a cohort, retrospective, descriptive and observational study. Clinical, laboratory and nutritional characteristics were identified, followed by sarcopenia investigation and cluster analysis, with follow-up of clinical outcomes of patients in maintenance hemodialysis. For sarcopenia diagnosis, body composition evaluation was performed using unifrequencial bioimpedance and handgrip strength. To compare the samples with and without sarcopenia, Student's t-test, Mann-Whitney, or Chi-square were used. Ward method was used for cluster analysis. ANOVA test, Tukey test or Kruskal Wallis, followed by Dunnet test were used for comparisons. Using this cut-off to fit the Kaplan-Meier survival curve. The level of significance was set at p <0.05. Results: 174 patients evaluated, 37.9% were diagnosed with sarcopenia. Patients with and without sarcopenia were different in relation to age, Kt/V, creatinine, hematocrit, high density lipoprotein, and all aspects of anthropometric, mass and muscle strength evaluation. The comparison among the clusters showed differences in sex, age, Kt/V, creatinine, urea, albumin, hematocrit, lymphocyte, 25-hydroxyvitamin D, phosphate, iron, bicarbonate, C-reactive protein, total cholesterol, high density lipoprotein, triglycerides, body mass index, percent standard of mid-arm circumference and triceps skinfold thickness, body composition, and muscle function. Kaplan-Meier not showed relation in outcomes. Conclusion: Clinical and nutritional aspects in the five clusters of this study showed heterogeneous characteristics of the disease, that may be related to different outcomes. This suggests an alternative to particularize the treatment and follow-up, acting with greater effectiveness in the clusters.
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Palavras-chave
Hemodiálise, Sarcopenia, Análise de clusters, Hemodialysis, Sarcopenia