Avaliação do consumo alimentar na hemodiálise e no período interdialítico, do estado nutricional e da qualidade de vida de pessoas idosas
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Data
2023-04-13
Tipo de documento
Dissertação
Título da Revista
ISSN da Revista
Título de Volume
Área do conhecimento
Ciências da Saúde
Modalidade de acesso
Acesso aberto
Editora
Autores
Prado, Flavia Ferreira
Orientador
de Aquino, Rita de Cássia
Coorientador
Scapini, Katia Bilhar
Resumo
INTRODUÇÃO: No Brasil as pessoas idosas compreendem o grupo com idade maior ou
igual a 60 anos, e esse grupo populacional vêm crescendo no país e no mundo, assim
com a incidência de doenças crônicas, como a doença renal. A doença renal crônica
(DRC) é a perda gradativa da função fisiológica dos rins e, no estágio final da doença, é
necessária terapia renal substitutiva, sendo a mais frequente a hemodiálise (HD). A HD
é um tratamento que consiste em um processo que realiza as trocas de substâncias entre
o sangue e o líquido da diálise, removendo toxinas e excesso de eletrólitos e líquidos. O
consumo alimentar dos indivíduos que realizam hemodiálise pode sofrer modificações
decorrentes da necessidade do tratamento. OBJETIVO: Avaliar o consumo alimentar de
pessoas idosas com doença renal crônica (DRC) na hemodiálise e no período
interdialítico, o estado nutricional e a qualidade de vida. CASUÍSTICA E MÉTODOS:
Estudo realizado com 40 pessoas idosas que realizam tratamento hemodialítico em uma
clínica de hemodiálise. A coleta consistiu no levantamento de dados pessoais, de saúde,
dados bioquímicos e composição corporal (entrevista e coleta em prontuário eletrônico),
avaliação subjetiva do estado nutricional, força de preensão manual, qualidade de vida e
consumo alimentar. No prontuário foi levantado os últimos níveis registrados de albumina
sérica e os valores resultantes da última bioimpedância específica (BCM). Após a
assinatura do TCLE, no primeiro momento foi entregue um caderno para registro
alimentar, onde anotou-se os alimentos consumidos em quatro dias, em um período de
uma semana (dois dias em que realiza HD e dois dias que não realiza HD). Para a
avaliação subjetiva do estado nutricional foi aplicado o instrumento “Avaliação Subjetiva
Global de 7 pontos” e para avaliação da qualidade de vida o instrumento denominado
KDQOL-SF (Kidney Disease Quality of Life -Short Form). Os indivíduos foram
acompanhados no período de coleta de dados para sanar dúvidas decorrentes ao
preenchimento do registro alimentar. Os alimentos e preparações dos quatro registros
alimentares foram convertidos de medidas usuais para quantidades em peso ou volume,
foi realizado a avaliação de macro e micronutrientes com o uso do software NDSR da
Universidade de Minessota (EUA) e realizado ajuste de variabilidade pelo método MSM
(Multiple Source Method). Foi utilizado para a análise dos dados e para avaliar as
diferenças um nível de significância de 5%. Resultados: A média de idade observada foi
68,4 anos, com prevalência de eutrofia. Os níveis de albumina mantiveram-se
adequados, acima das recomendações. Houve uma alta porcentagem de sarcopenia de
acordo com o índice de massa muscular pela bioimpedância (62,5%). Com relação à
qualidade de vida, o escore mais baixo foi o relacionado ao status de trabalho (32,05 ±
40,53) e carga da doença renal (34,62 ± 21,31). O consumo alimentar foi menor nos dias
de hemodiálise para energia, gorduras, proteína total, proteína animal, fibras totais, fibras
insolúveis e aminoácido leucina. A maioria das vitaminas e minerais apresentaram
diferenças significativas no consumo alimentar, sendo a ingestão menor nos dias de HD.
Observou-se correlação entre força de preensão manual e índice de massa corporal para
mulheres. A qualidade de vida e o consumo alimentar de proteínas se correlacionaram
no sexo masculino com o consumo de energia, dor e fadiga e o consumo de proteína
relacionado a dor. Conclusão: As pessoas idosas com doença renal estudadas
apresentaram o consumo alimentar inadequado e menor nos dias que realizam HD, a
maioria apresentou sarcopenia e comprometimento na qualidade de vida, o que
demonstra a importância da atuação da equipe interdisciplinar e do nutricionista no
aconselhamento e na suplementação nutricional, e no planejamento adequado de
refeições na clínica de diálise.
INTRODUCTION: In Brazil, elderly people comprise the group aged 60 years or older, and this population group has been growing in the country and in the world, as well as the incidence of chronic diseases, such as kidney disease. Chronic kidney disease (CKD) is the gradual loss of regulatory function of the kidneys and, in the final stage of the disease, renal replacement therapy is required, the most frequent being hemodialysis (HD). HD is a treatment that consists of a process that performs the exchange of substances between the blood and the dialysis fluid, removing toxins and excess electrolytes and fluids. The food consumption of individuals who started hemodialysis may change due to the need for treatment. OBJECTIVE: To evaluate the dietary intake of elderly people with chronic kidney disease (CKD) undergoing hemodialysis and the interdialytic period, nutritional status and quality of life. PATIENTS AND METHODS: Study carried out with 40 elderly people who idealize hemodialysis treatment in a hemodialysis clinic. The collection consists of collecting personal data, health, biochemical data and body composition (interview and electronic medical record collection), subjective assessment of nutritional status, handgrip strength, quality of life and food consumption. The last recorded levels of serum albumin and the values resulting from the last specific bioimpedance (BCM) were collected from the medical record. After signing the TCLE, at first, the patient was given a notebook for food records, where he wrote down the foods consumed in four days, in a period of one week (two days in which he performs HD and two days in which he does not perform HD). For the subjective assessment of nutritional status, the instrument “Subjective Global Assessment of 7 points” was applied, and for the assessment of quality of life, the instrument called KDQOL-SF (Kidney Disease Quality of Life -Short Form). The patients were followed up during the data collection period to resolve doubts arising from completing the food record. The foods and preparations from the four food records were converted from usual measurements to weight or volume, an assessment of macro and micronutrients was performed using the NDSR software from the University of Minnesota (USA) and variability adjustment was performed using the MSM method ( Multiple Source). It was used for data analysis and to evaluate variation at a 5% significance level. RESULTS: The average age observed was 68.4 years, with a prevalence of eutrophy among patients. Albumin levels remained adequate, above the recommendations. There was a high percentage of sarcopenia according to the muscle mass index by bioimpedance (62.5%). With regard to quality of life, the lowest score was related to work status (32.05 ± 40.53) and burden of kidney disease (34.62 ± 21.31). Food consumption was lower on hemodialysis days for energy, vitamin, total protein, animal protein, total fiber, insoluble fiber and leucine amino acid. Most vitamins and minerals showed differences in food intake, with lower intake on HD days. Observe naturally between handgrip strength and body mass index for women. Quality of life and dietary protein intake were correlated in males with energy intake, pain and fatigue, and protein intake related to pain. CONCLUSION: The older people with kidney disease studied had inadequate and lower food consumption on days undergoing hemodialysis, most had sarcopenia and compromised quality of life, which demonstrates the importance of the role of the interdisciplinary team and the nutritionist in counseling and supplementation nutrition, and proper meal planning in the dialysis clinic.
INTRODUCTION: In Brazil, elderly people comprise the group aged 60 years or older, and this population group has been growing in the country and in the world, as well as the incidence of chronic diseases, such as kidney disease. Chronic kidney disease (CKD) is the gradual loss of regulatory function of the kidneys and, in the final stage of the disease, renal replacement therapy is required, the most frequent being hemodialysis (HD). HD is a treatment that consists of a process that performs the exchange of substances between the blood and the dialysis fluid, removing toxins and excess electrolytes and fluids. The food consumption of individuals who started hemodialysis may change due to the need for treatment. OBJECTIVE: To evaluate the dietary intake of elderly people with chronic kidney disease (CKD) undergoing hemodialysis and the interdialytic period, nutritional status and quality of life. PATIENTS AND METHODS: Study carried out with 40 elderly people who idealize hemodialysis treatment in a hemodialysis clinic. The collection consists of collecting personal data, health, biochemical data and body composition (interview and electronic medical record collection), subjective assessment of nutritional status, handgrip strength, quality of life and food consumption. The last recorded levels of serum albumin and the values resulting from the last specific bioimpedance (BCM) were collected from the medical record. After signing the TCLE, at first, the patient was given a notebook for food records, where he wrote down the foods consumed in four days, in a period of one week (two days in which he performs HD and two days in which he does not perform HD). For the subjective assessment of nutritional status, the instrument “Subjective Global Assessment of 7 points” was applied, and for the assessment of quality of life, the instrument called KDQOL-SF (Kidney Disease Quality of Life -Short Form). The patients were followed up during the data collection period to resolve doubts arising from completing the food record. The foods and preparations from the four food records were converted from usual measurements to weight or volume, an assessment of macro and micronutrients was performed using the NDSR software from the University of Minnesota (USA) and variability adjustment was performed using the MSM method ( Multiple Source). It was used for data analysis and to evaluate variation at a 5% significance level. RESULTS: The average age observed was 68.4 years, with a prevalence of eutrophy among patients. Albumin levels remained adequate, above the recommendations. There was a high percentage of sarcopenia according to the muscle mass index by bioimpedance (62.5%). With regard to quality of life, the lowest score was related to work status (32.05 ± 40.53) and burden of kidney disease (34.62 ± 21.31). Food consumption was lower on hemodialysis days for energy, vitamin, total protein, animal protein, total fiber, insoluble fiber and leucine amino acid. Most vitamins and minerals showed differences in food intake, with lower intake on HD days. Observe naturally between handgrip strength and body mass index for women. Quality of life and dietary protein intake were correlated in males with energy intake, pain and fatigue, and protein intake related to pain. CONCLUSION: The older people with kidney disease studied had inadequate and lower food consumption on days undergoing hemodialysis, most had sarcopenia and compromised quality of life, which demonstrates the importance of the role of the interdisciplinary team and the nutritionist in counseling and supplementation nutrition, and proper meal planning in the dialysis clinic.
Palavras-chave
Pessoa Idosa, Diálise Renal