Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-01-26T13:27:51Z No. of bitstreams: 1 RAFAELA_SIVIERO_CARON_LIENERT_TES.pdf: 9419976 bytes, checksum: f123a0ee4d12fb6dd455c726f40ece4f (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-01-31T13:24:29Z (GMT) No. of bitstreams: 1 RAFAELA_SIVIERO_CARON_LIENERT_TES.pdf: 9419976 bytes, checksum: f123a0ee4d12fb6dd455c726f40ece4f (MD5) / Made available in DSpace on 2018-01-31T13:29:24Z (GMT). No. of bitstreams: 1 RAFAELA_SIVIERO_CARON_LIENERT_TES.pdf: 9419976 bytes, checksum: f123a0ee4d12fb6dd455c726f40ece4f (MD5) Previous issue date: 2017-11-21 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Background: During 24 hours of peritoneal dialysis (PD), it is estimated that 100 to 300g of the glucose are absorbed, which can generate metabolic changes and nutritional disorders. Objective: To study pathophysiological and clinical aspects related to nutritional status of PD patients. Materials and Methods: Observational study of PD patients evaluating body composition by bioimpedance (Body Composition Monitor; Fresenius Medical Care), examining peritoneal membrane characteristics, measuring biochemical parameters and using inductively coupled plasma mass spectrometer to measure serum concentrations of copper (63Cu), zinc (66Zn), selenium (78Se), chromium (52Cr) and nickel (58Ni). Results for each paper: Article 1: After 1y on PD, 50.6% had dry weight (DW) gain, 41.2% showed lean tissue mass (LTM) loss, and 65.9% presented fat mass (FM) gain and significant differences in DW, body mass index (BMI), adipose tissue mass (ATM), FM and fat tissue index (FTI) were disclosed. Patients with lower dialysate-to-plasma creatinine ratio showed FM gain. We observed a higher percentage of nonfast transporters in DW gain when comparing with no gain. Artigo 2: No differences were disclosed regarding body composition changes between PD modalities (CAPD and APD). Article 3: At baseline 29.9% of the patients were classified as having undernutrition (Lean Tissue Index (LTI) percentile <10th), 55.5% as obese (FTI percentile >90th), 7.9% as having fat tissue undernutrition (FTI percentile <10th) and 23.8% had LTI undernutrition and obesity in combination. The cumulative survival rates were 92%, 83%, 69%, 67% and 60% (12, 24, 36, 48 and 60 months, respectively). Kaplan-Meier survival and Cox regressions analysis showed that only PhA bellow 5? had an impact on mortality during the follow-up, even after adjusting for age, gender and diabetes. Artigo 4: Values below references were disclosed for Zn (5.8 ? 1.1 ?mol/L) in 100%; Cu (15.7 ? 5.0 ?mol/L) in 20.7%; Se (0.59 ? 0.22 ?mol/L) in 75.9%. Values above references were disclosed for Cr (0.29 ? 0.08 ?mol/L) in 86.3% and Ni (0.21 (0.17 ? 0.26) ?mol/L) in 96.6%. We observed significant positive corretations between Cu and DW (r=0.407, P=0.028), BMI (r=0.460, P=0.012) and FTI (r=0.370, P0.048). Zn was positivily correlated to albumin (r=0.527, P=0.003) and negatively correlated with OH (r=-0.394, P=0.034) and extracellular water (%ECW) (r=-0.466, P=0.014). Se had a positive correlation with serum albumin (r=0.515, P=0.005) and total cholesterol (r=0.443, P=0.021), but a negative correlation with %ECW (r=-0.404, P=0.041) and extracellular water/intracellular water (r=0.398, P0.036). Ni was negatively correlated to dry weight (r=-0.377, P0.044). Cu/Zn ratio was only correlated to BMI (r=0.376, P=0.044). Conclusions: Body composition changes over PD treatment and it does not seems to be related to the exposure of glucose or to the PD modality, however, it seems to be related to patients with slower peritoneal transports at the beginning of the treatment. Detailed analysis of body composition can generate more accurate data of nutritional status. The use of the phase angle as a marker of nutritional status is suggested and further studies are needed to better understand the association of serum microelements and body composition in this population. / Introdu??o: Durante 24 horas de Di?lise Peritoneal (DP), estima-se que cerca de 100 a 300g da glicose s?o absorvidas, o que pode gerar altera??es metab?licas e no estado nutricional. Objetivos: Estudar aspectos fisiopatol?gicos e cl?nicos relacionados ao estado nutricional de pacientes em DP. Materiais e m?todos: Estudo observacional de pacientes em DP com an?lise da composi??o corporal atrav?s da bioimped?ncia espectrosc?pica (Body Composition Monitor, Fresenius Medical Care), avalia??o da caracter?stica de transporte peritoneal, exames bioqu?micos e concentra??o s?rica de cobre (63Cu), zinco (66Zn), sel?nio (78Se), cromo (52Cr) e n?quel (58Ni) atrav?s de espectometria de massa com plasma indutivamente acoplado. Resultados por artigo: Artigo 1: Ap?s 1 ano de DP, 50,6% ganharam peso, 41,2% perderam massa magra, 65,9% aumentaram massa gorda, sendo encontrado aumento significativo para peso, ?ndice de massa corporal (IMC), tecido adiposo e ?ndice de massa gorda. Os pacientes que ganharam peso predominantemente apresentavam baixo transporte peritoneal. Artigo 2: A modifica??o da composi??o corporal encontrada n?o foi diferente entre modalidades de DP, ambulatorial cont?nua (CAPD) e automatizada (APD). Artigo 3: No in?cio da DP, os pacientes foram classificados em: 29,9% desnutridos (massa magra percentil <10), 55,5% obesos (massa gorda percentil >90) e 7,9% como desnutridos por massa gorda (massa gorda percentil <10) e 23,8% desnutri??o e obesidade em combina??o. A sobrevida cumulativa foi de 92%, 83%, 69%, 67% e 60% (12, 24, 36, 48 e 60 meses, respectivamente). O ?ngulo de fase (abaixo de 5?) possui impacto na mortalidade, inclusive ap?s ajuste para idade, sexo e diabetes. Artigo 4: Valores abaixo da refer?ncia foram observados para Zn (5,8 ? 1,1 ?mol/L) em 100%; Cu (15,7 ? 5,0 ?mol/L) em 20,7%; Se (0,59 ? 0,22 ?mol/L) em 75,9%. Valores acima do recomendado foram encontrados para Cr (0,29 ? 0,08 ?mol/L) em 86,3% e Ni (0,21 (0.17 ? 0.26) ?mol/L em 96,6%. Foi observada correla??o positiva entre Cu e peso seco (r=0,407, P=0,028), IMC (r=0,460, P=0,012) e ?ndice de massa gorda (r=0,370, P0,048). Zn apresentou correla??o positiva com albumina (r=0,527, P=0,003) e negativa com hiperhidrata??o (r=-0,394, P=0,034) e percentual de ?gua extracelular (r=-0,466, P=0,014). Se apresentou correla??o positiva com albumina (r=0,515, P=0,005) e colesterol total (r=0,443, P=0,021), mas negativa com percentual de ?gua extracelular (r=-0,404, P=0,041) e ?gua extracelular/?gua intracelular (r=0,398, P0,036). Ni correlacionou-se negativamente com peso seco (r=-0,377, P0,044). Cu/Zn apresentou correla??o com IMC (r=0,376, P=0,044). Conclus?es: A composi??o corporal de pacientes em DP se modifica ao longo do tratamento, o que n?o parece estar relacionado a exposi??o a glicose ou ? modalidade de DP, por?m, as altera??es parecem estar relacionadas ? pacientes que apresentam transportes peritoneais mais lentos no in?cio da terapia. A an?lise da composi??o corporal de forma detalhada pode gerar dados mais precisos de avalia??o nutricional. Sugere-se o uso do ?ngulo de fase como um marcador de estado nutricional e mais estudos s?o necess?rios para o melhor entendimento da associa??o de microelementos s?ricos e composi??o corporal nesta popula??o.