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Title: The relationship between activation of non-specific inflammatory process, effectivness of dialysotherapy and progression of malnutrition in patients on peritoneal dialysis


The aim of the study was assessment of the nutritional status of patients with ESRD on peritoneal dialyses and relationships between activation of non-specific inflammatory process, effectivness of dialysotherapy and malnutrition. The study group included 60 patients (33 M 27 F) aged from 19 to 77 years (mean 50,44 +/- 14 years) on peritoneal dialysis treated in the Department of Nephrology, University Hospital in Cracow. Patients with an active inflammatory process, such as hepatitis B or C or rheumatoid arthritis were excluded. The entire 24-month observation period was completed by 59 patients, 1 patient died (1,7%). 3 of them were transferred to HD (because of infectious complications), and 10 (16,7%) of them received kidney grafts. Nutritional status was assessed by using SGA scale, anthropometric data, bioimpendancy, and biochemical parameters. Adequacy of the dialysis was measured by Kt/V and TKK coefficients, peritoneal equilibration was measured by the PET test, inflammatory process was assessed by cytokine and acute phase protein concentrations (IL-6 and TNFa, CRP, fibrynogen, leptin and lipoprotein (a)). After 2 years of the observation, indexes of dialysis adequacy (Kt/V and TKK) did not reveal significant changes. No relationship between adequacy parameters and nutritional status nor residual renal function was found. No differences in nutritional and inflamm ; atory parameters were observed among patients with different DIP coefficient. Acute phase proteins and cytokines did not reveal any correlations to RRF, Kt/V and TKK coefficients. The mean concentrations of: C-reactive protein (4,8mgll), IL-6 (3,45 pglml) and leptin (22,95 nglml) were above reference level. Positive correlation among inflammatory markers, anthropometric data and bioimpendancy were found in the observed population. The body weight was positively correlated with IL-6, TNF and C-reactive protein. BMI and W/H was also positively correlated with IL~6, TNF, C-reactive protein and with fibrinogen. Leptine was positively correlated with CRP and TNF. Albumin has shown negative, statistically siginificant correlation between CRP, IL-6 and fibrinogen. The nutritional status was constant over 2 years of observation. Considering biochemical factors and anthropometric data, significant increase of total body weight (71,88 ± 13,98 kg versus 73,48 ± 13,81 kg) was proven. The increase of BMI (25,92 ± 4,29 versus 26,69 ± 4,02 kglm2) was on the limit of statistical significance. However, because no statistical difference among nutritional parameters (E/H R, MAMC, LBM and TBF) was observed and the fact, that DIP coefficient rose, overhydration was caused the increase of mean body weight and BMI. The mean albumin level significantly decreased after 24 months of observation ( ; 39,55 ± 3,5 i 37,63 ± 3,7 gil respectively). At the time of the last examination, 16 patients compared to 7 of the first, had albumin level below 35gll. Two of them had albumin level even below 30 gil. The lymphocyte level rose slightly without statistical significance. Both IL-6 and TNFa concentration significantly increased (3,45 versus 4,9 versus 6,8 pglml and TNFa 4,05 versus 5,6 versus 6,2 pglml respectively) during the whole period ofresearch. Leptin concentration showed no statistical significance during 12 and 24 months of the observation. The number of infectious complications and hospitalization rate corresponded to literature. Significant higher concentration of TNFa was observed for patients who were hospitalized. Thus, there was no relation with other inflammatory markers and albumin level.

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2 - studia doktoranckie

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Wydział Lekarski


Sułowicz, Władysław

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Oct 24, 2022

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Nov 21, 2012

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ZB-102946 Oct 24, 2022


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