Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
The Effect of Gastrointestinal Symptoms on Objective Criteria of Malnutrition in Dialysis Patients: Cross-Sectional Research
Diyaliz Hastalarında Gastrointestinal Semptomların Malnütrisyonun Objektif Kriterlerine Etkisi: Kesitsel Araştırma
Refika BÜBERCİa, Semahat KARAHİSAR ŞİRALİa, Murat DURANAYa
aClinic of Nephrology, Ankara Training and Research Hospital, Ankara, Türkiye
Turkiye Klinikleri J Med Sci. 2023;43(1):83-9
doi: 10.5336/medsci.2022-91804
Article Language: EN
Full Text
ABSTRACT
 Objective: Gastrointestinal symptoms are common in chronic kidney disease (CKD) patients. This situation creates a tendency toward malnutrition. The aim of the current study was to determine the causes of gastrointestinal symptoms and to evaluate their effect on Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score which are the objective criteria to detect malnutrition. Material and Methods: A total of 66 hemodialysis and 51 peritoneal dialysis patients were included in this study. Patients were divided into two groups. Group I consisted of 26 patients who answered more than 50% of the 16 questions on a gastrointestinal symptoms Likert-type questionnaire as 'frequently' or 'very frequently'. Laboratory and demographic features of patients were recorded. PNI score was calculated using the formula: [10×serum albumin value (g/dL)]+ (0.005×lymphocyte count/mm3). CONUT score was calculated by summing the scores given to certain ranges of total lymphocyte count, albumin, and total cholesterol value. A low PNI and high CONUT score indicates nutritional deficiencies. Result: There was no difference in demographic characteristics between groups. PNI score was lower and CONUT score was higher in Group I. Diabetes mellitus (DM) and CRP-albumin ratio (CAR) were found to be independent risk factors in the development of gastrointestinal symptoms. In multivariate regression analysis, it was observed that DM, non-steroidal antiinflammatory drugs (NSAID) use, and CAR elevation rather than gastrointestinal symptoms affect the CONUT and PNI scores. Conclusion: DM and inflammation play roles in the development of gastrointestinal symptoms. Malnutrition is affected not only by gastrointestinal symptoms but also by underlying additional diseases, some drugs such as NSAID, and inflammation in dialysis patients.

Keywords: Controlling Nutritional Status score; dialysis; gastrointestinal symptoms; malnutrition; Prognostic Nutritional Index
ÖZET
 Amaç: Gastrointestinal semptomlar kronik böbrek hastalarında (KBH) yaygın görülür. Bu durum malnütrisyona eğilim yaratır. Mevcut çalışmanın amacı, gastrointestinal semptomların nedenlerini tespit etmek ve malnütrisyonu değerlendiren objektif kriterlerden olan Prognostik Beslenme İndeksi [Prognostic Nutritional Index (PNI)] ve Kontrollü Beslenme Durum [Controlling Nutritional Status (CONUT)] skoru üzerine etkisini değerlendirmektir. Gereç ve Yöntemler: Çalışmaya 66 hemodiyaliz, 51 periton diyaliz hastası alındı. Hastalar iki gruba ayrıldı. Gastrointestinal semptomları değerlendirmek için 16 sorudan oluşan Likert tipi anketteki soruların %50'den fazlasına 'sık' veya 'çok sık' cevaplarını veren 26 hasta Grup 1'i oluşturdu. Hastaların demografik ve laboratuvar verileri kaydedildi. PNI [10×serum albumin değeri (g/dL)]+ (0,005×lenfosit sayısı/mm3) formülüyle hesaplandı. CONUT skoru lenfosit sayısının, albumin değerinin ve total kolesterolün belirli aralıklarına puan verip, toplamı olarak hesaplandı. Düşük PNI ve yüksek CONUT skoru beslenme eksikliğini gösterir. Bulgular: İki grup arasında demografik özellikler açısından fark yoktu. Grup 1'de PNI düşük, CONUT skoru yüksek bulundu. Diabetes mellitus (DM) ve C-reaktif protein-albumin oranı (CAO) gastrointestinal semptomların gelişimi açısından bağımsız birer risk faktörü olduğu tespit edildi. Çok değişkenli regresyon analizinde gastrointestinal semptomlardan ziyade DM, CAO yüksekliği ve nonsteroid antiinflamatuar ilaç (NSAİİ) kullanımının PNI ve CONUT skorunu etkilediği tespit edildi. Sonuç: DM ve inflamasyon gastrointestinal semptomların gelişiminde rol oynamaktadır. Malnütrisyon diyaliz hastalarında sadece gastrointestinal semptomlardan değil aynı zamanda altta yatan ek hastalıklardan, NSAİİ gibi bazı ilaçlardan ve inflamasyondan etkilenmektedir.

Anahtar Kelimeler: Kontrollü beslenme durum skoru; diyaliz; gastrointestinal semptomlar; malnütrisyon; Prognostik Beslenme İndeksi
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