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Previous issue date: 2013-07-30 / Background: Fluid overload (FO) is common in patients on PD and the combination with inadequate nutritional status causes increased mortality in peritoneal dialysis (PD) patient. Bioimpedance spectroscopy is a precise, sensitive and reliable tool for determining the fluid volume status and body composition of PD patients. The main aims of this study were: to compare body composition and volume variables, measured with the dialysis fluid inside the peritoneal cavity (CC) and after its drainage (EC), using the Body Composition Monitor (BCM); and to evaluate associations of the nutritional status and body composition of patients receiving PD, with their volume status.
Methods: A cross-sectional study involving 37 stable adult patients (>18 years) on PD. A BCM report was used for the analysis of fluid status and body composition, and was conducted with both a CC and EC.
Results: The study sample had the following characteristics: 62.5% female, 68.8% Caucasian, 75.0% on continuous ambulatory peritoneal dialysis (CAPD) and 25.0% on peritoneal dialysis automatized (APD). Evaluation of 32 patients showed no statistical difference between CC and EC in regard to overhydration (OH), total body water, extracellular water, intracellular water and their corrections for height and weight, lean tissue mass, fat tissue mass and their indices, adipose tissue mass, and body cell mass. Pearson's correlation coefficient of OH between CC and EC was r=0.989 (P<0.001). Bland-Altmann plot for OH full and OH empty had a line of bias of -9 mL and 95% limits of agreement from -603 to 585 ml. In another analysis with 37 patients serum albumin was higher in euvolemic (EV) patients (P=0.013), and the Subjective Global Assessment and Malnutrition Inflamation Score were higher in OH patients (P=0.002 and P=0.004, respectively). All hypertensive patients were diagnosed as OH. Several correlations were disclosed between nutritional markers and body composition markers and volemia.
Conclusion: The presence of intraperitoneal fluid does not interferes with the evaluation of hydration status using BCM, or in the analysis of corporal composition - lean tissue mass, fat tissue mass, adipose tissue mass and their indices, suggesting that the BCM methodology can be applied in both conditions, with or without drainage of the dialysate solution. Besides the volume status of PD patients has a strong association with nutritional assessment variables. Consequently, a detailed evaluation of volume status should be part of a complete nutritional assessment, aiming an appropriate nutritional state. / Introdu??o: A sobrecarga h?drica (SH) ? um achado comum em pacientes em di?lise peritoneal (DP) e a combina??o com a inadequa??o do estado nutricional aumenta a mortalidade desta popula??o. A bioimped?ncia espectrosc?pica ? uma ferramenta precisa, sens?vel e confi?vel para determinar o estado vol?mico e a composi??o corporal de pacientes em DP. O principal objetivo deste estudo foi: comparar a composi??o corporal e as vari?veis de volume, medidas com o l?quido de di?lise presente na cavidade peritoneal (CC) e ap?s este ser drenado (EC), atrav?s do Body Composition Monitor (BCM); e avaliar as rela??es do estado nutricional e composi??o corporal de pacientes em DP de acordo com a volemia. M?todos: Estudo transversal, envolvendo 37 pacientes adultos (>18anos de idade) est?veis em DP. Os dados gerados pelo BCM foram utilizados para an?lise da volemia e da composi??o corporal, realizados em dois momentos, CC e EC. Resultados: As caracter?sticas da amostra em estudo foram: 62,5% mulheres, 68,8% caucasianos, 75,0% em CAPD e 25,0% em APD. A avalia??o de 32 pacientes mostrou que n?o h? diferen?a estat?stica entre CC e EC em rela??o ? hiper-hidrata??o (OH), ?gua corporal total, intra e extracelular e suas corre??es por altura e peso, massa magra, massa gorda e seus ?ndices, massa de tecido adiposo e massa celular corporal. A correla??o de Pearson entre OH-CC e OH-EC apresentou valor de r=0,989 (P<0,001). Bland-Altmann plot para OH-CC e OH-EC mostrou linha de vi?s de -9mL e 95% de limites de concord?ncia (-603 a 585 mL). Em outra an?lise com 37 pacientes a albumina s?rica foi maior em pacientes euvol?micos (EV) (P=0,013), e a Avalia??o Subjetiva Global e o Escore de Desnutri??o-Inflama??o foram maiores em pacientes hiperhidratados (P=0,002 e P=0,004, respectivamente). Todos hipertensos foram diagnosticados como hiperhidratados. Diversas correla??es foram encontradas entre marcadores de estado nutricional e composi??o corporal com volemia. Conclus?o: A presen?a de l?quido intraperitoneal n?o interfere na avalia??o do estado de hidrata??o atrav?s do uso do BCM, assim como a an?lise da composi??o corporal massa magra, massa gorda, massa de tecido adiposo e seus ?ndices sugerindo que a metodologia do BCM pode ser aplicada em ambas as condi??es, com e sem o l?quido presente na cavidade peritoneal. Al?m disso, as vari?veis de volemia estudadas apresentam forte associa??o com vari?veis de estado nutricional. Com isso, observa-se que uma avalia??o detalhada do estado de hidrata??o deve fazer parte da avalia??o nutricional criteriosa, visando determinar corretamente o estado nutricional destes pacientes.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/1754 |
| Date | 30 July 2013 |
| Creators | Lienert, Rafaela Siviero Caron |
| Contributors | Figueiredo, Carlos Eduardo Poli de |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, BR, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 500, 600, -8624664729441623247 |
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