The evaluation of nutrition parameters, antropometric measurements and malnutrition frequencies in stage 3-4 chronic renal failure patients

Aim: CVD is the most common reason of mortality and morbidity in renal failure disease patients. It may seem puzzling that whereas hypoalbuminaemia [16,17] and inflammation [7,9] have been shown to be important predictors of mortality in dialysis patients, complications from malnutrition and inflammation as such are not among the most common causes of mortality. In fact, malnutrition accounts for only 1-2% of deaths in renal patients [18], while atherosclerotic CVD is by far the most common cause of mortality in the dialysis population [1]. How can this paradox best be explained? One possible explanation may be the strong documented interactions between atherosclerotic CVD and inflammatory as well as nutritional parameters in ESRD patients [15]. Based on these findings, we have suggested the presence of a syndrome (MIA) consisting of malnutrition, inflam¬mation and atherosclerosis [19]. This syndrome is present in a considerable proportion of patients who start dialysis treatment, and is associated with a high mortality rate [2].İn our study we aimed ;to show the risks of malnutrition,inflamation and atherosklerosis in stage 3-4 chronic renal disease.Material - Method: This study includes 90 patients who has stage 3-4 chronic renal disease that has been treated in nefrology and endocrine clinic and that has applied to endocrine policlinic of DÜTF in 2009.Demographic charasteristics of patients is received from patients and their files.Sistolic and diastolik blood pressures of all patients has been received Ürea, Kreatinin, Na, K, Ca, Alb, Phospor, ALT, AST, ALP, T.protein, T.cholesterol, LDL, Vit B12, Folat,Fe,TSİ, Ferritin, CRP, TNFalfa, IL1, IL6, Lp(a), EPO,PTH, HbA1C, Htc and PLT values is studied.Mid arm muscle circumference, triceps skin thickness and waist circumferenceof all patients has measured.BMI,creatin clirence and ESBAH is calculated.KİMK is measured with doppler USG and LAD is measured with ECHO.Findings: The average age of stage 3 chronic renal disease was 47+/-14.95 year and state 4 was 55.35+/-10.75 year.To the age average there was a statistically significant difference between this groups(p=0,05)İn our study as statistically there was no significant difference in anthropometric measurements of stage 3-4 chronic renal disease patients.(p>0.05).İn this two groups the nutrition parameters like cholesterol levels has no difference(p>0.05) but albumin levels has statistically significant difference(p<0.05).Lp(a); which is one of atherosclerosis parameters has statistically significant differenece.(p<0.05)CIMT has no difference(p>0.05).Demographic characteristics like gender has no statistically significant difference(p>0.05) but age has(p<0.05).İn two groups there was significant difference in GFR(p<0.05).İn hematologic parameters like wbc,pmnl and plt has no statistically significant difference(p>0.05) but hgb and htc has.(p<0.05).Biochemical parameters like Fe, TSI, ferritin, vit B12, EPO, K, phospor has no statistically significant difference(p>0.05) but PTH, folat, T.protein, Na, Ca, Urea, creatinin has(p<0.05).There was statistically significant difference and positive correlation between Cr clirence and albumin, hgb,htc,plt, TDBK, folat, T.protein and Ca levels(p<0.005)There was statistically significant difference and negative correlation between cr. Clirence and age, TNF alfa, PTH, Na, urea,creatinin(p<0.05).There was no statistically significant differnce between cr clirence and BMI, waist circumference, arm circumference, triceps skin thickness,sistloic, diastolic blood pressure, wbc,pmnl,crp,IL1ß, IL6,Lp(a), fe, ferritin, B12,EPO, T cholesterol,K, P levels(p>0.05).Conclusion:1)İn CRD as stage increases, frequency of malnutrisyon is also inreases. (Level-3: %48, Level-4:%66.5) İn CRD patients whic has no dializ terap,serum albumin levels that is result of malnutrisyon is decreasess but anthropometric measurements has no changes.2)IL1,IL6,CRP and TNF alfa are strong determinants of inflamation.A positive significant corelation has been found between Cr Clirence and TNFalfa.But it hasn?t found any corelation between Cr Clirence and IL1,IL6 and CRP.3)İt hasn?t found any corelation between CRclirence and CİMA.