Relação entre sarcopenia e risco cardiovascular em portadores de doença renal crônica em tratamento dialítico

Abstract

Introduction: Chronic kidney disease (CKD) is an important worldwide public health problem, consists of kidney damage and/or slow, progressive, irreversible loss of kidney functions and has high morbidity and mortality. Recent evidence suggests sarcopenia as a useful condition for cardiovascular events in the CKD. Objective: To analyze an association between sarcopenia and cardiovascular risk in patients with CKD on automated peritoneal dialysis (APD) (article 1), on hemodialysis (HD) (article 2) and develop a clinical protocol for nutritional assistance for patients with CKD on HD (product). Methods: Cross-sectional analytical study, with CKD patients undergoing dialysis (APD and HD), both sexes, over 18 years of age, and more than three months in analyzes. The variables evaluated were: dialysis time, anthropometric measurements; presence of comorbidities; serum levels of albumin, creatinine, urea, ferritin, protein and calorie intake. Initially, the SARC-F instrument was applied to screen for sarcopenia. The assessment of muscle mass was performed by means of bioimpedance by spectroscopy, in addition to the measurement of handgrip strength, physical performance. Malnutrition was determined by the seven-point subject global assessment (SGA-7p). The cardiovascular risk was identified by the triglyceride/HDL-cholesterol ratio, considering a cut-off point ≥3,80. The level of significance considered was 5%. Results: The sample of article 1 (APD) was established by 52 participants, aged 53,90±14,86 years. A sample of article 2 (HD) was created by 74 participants, aged 57,1±27,6 years. In the APD, the prevalence of sarcopenia was 28,85% and the cardiovascular risk was 48,08%; in HD, sarcopenia was found in 31,10% and cardiovascular risk in 54,90% of the participants. This condition was predominant in males and in hypertensive patients (both treated on dialysis) and in the statistical difference between the presence of sarcopenia in relation to SGA-7p (in APD), phase angle and albumin, and the last variables in both APD and HD. Conclusion: Reduced levels of albumin increases 22,22 times as chances of sarcopenia in APD. The presence of hypertension was an independent factor for sarcopenia in HD. In the present, didn´t have found casual relationship between sarcopenia and cardiovascular risk, both in APD and HD, by the triglyceride/HDL-cholesterol ratio.