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      Does nutrition play a role in the quality of life of patients under chronic haemodialysis? Translated title: ¿Desempeña la nutrición un papel en la calidad de vida de los pacientes con hemodiálisis crónica?

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          Abstract

          Background: In patients with chronic renal failure under haemodialysis, we investigated the inter-relationships and relative contributions of disease, haemodialysis and of nutrition related factors on the patients' Quality of Life. Methods: Collected data in 60 adult patients comprised: co-morbidities (multiple medicines, other chronic diseases), duration of renal failure and of haemodialysis (in months), % weight loss since haemodialysis, nutrient intake derived from diet history analysis (DIETPLAN5 2003, UK). The EuroQoL instrument that includes 5 dimensions, mobility, self-care, activities, pain/discomfort, anxiety/depression, and an overall health visual analogue scale evaluated QoL. Results: Estimates of effect size attributed to each variable included in the general linear model revealed that 47% of patients' mobility/self-care scores were worsened by deficient protein/energy intake and 30% by weight loss=10%. Poor performance of usual activities was attributed in 45% to duration of haemodialysis and of disease, 70% to protein/energy/vitamin B12/zinc/iron deficits, and 20% to weight loss =10%. Pain/discomfort were worsened in 45% by the duration of haemodialysis and of disease,and in 15% by co-morbidities. Higher anxiety/depression were related in 43% to protein/energy/selenium & vitamin C deficits, in 40% to the duration of haemodialysis and of disease, in 10% to weight loss =10%, and in 3% to co-morbidities. Likewise, 47% of poor overall health was determined by protein/energy/vitamin B12/zinc/selenium & vitamin C deficits, 25% by weight loss=10%, 10% by disease duration, and 7% by co-morbidities. Conclusion: Protein, antioxidants and key micronutrients involved in protein metabolism, did exert a major effect on patients' Quality of Life. Given the prevalence of nutrient deficits, the ensuing impaired functional capacity is likely to compromise QoL, timely nutrition is thus warranted.

          Translated abstract

          Antecedentes: en pacientes con insuficiencia renal crónica y en hemodiálisis, investigamos las relaciones y contribuciones relativas de la enfermedad, hemodiálisis y factores nutricionales del paciente sobre la calidad de vida (QOL). Métodos: los datos recogidos de 60 pacientes adultos incluían: comorbilidades (múltiples fármacos, otras enfermedades crónicas), duración de la insuficiencia renal y hemodiálisis (en meses), % pérdida de peso desde la hemodiálisis, ingestión de nutrientes derivada del análisis de la historia dietética (DIETPLAN5, 2003, RU). La escala EuroQOL que incluye 5 dimensiones de movilidad, autocuidado, actividades, dolor / malestar, ansiedad/depresión, y una escala analógica visual sobre salud global, evaluó la QOL. Resultados: las estimaciones del efecto del tamaño atribuido a cada variable incluida en el modelo linear general mostraron que el 47% de las puntuaciones de los pacientes sobre movilidad/pérdida de peso empeoraban con una ingestión de deficiente de proteínas / energía y el 30% por una pérdida de peso ≥ 10%. El bajo rendimiento en las actividades habituales se atribuyó en un 45% a la duración de la hemodiálisis y de la enfermedad, el 70% a deficiencias de proteínas/energía/vitamina B12/cinc/hierro, y el 20% a una pérdida de peso ≥ 10%. El dolor/ansiedad empeoraban en un 45% por la duración de la hemodialysis y de la enfermedad, y en un 15% por comorbilidades. La mayor ansiedad/depresión se relacionó en un 43% con deficiencias de proteínas / energía/selenio y vitamina C, en un 40% por la duración de la hemodialysis y la enfermedad, en un 10% por una pérdida de peso ≥ 10%, y en un 3% a las comorbilidades. Asimismo, el 47% de la salud global mala vino determinado por deficiencias de proteína/energía/vitamina B12/cinc/selenio y vitamina C, 25% por pérdida de peso ≥ 10%, el 10% por la duración de la enfermedad, y el 7% por las comorbilidades. Conclusiones: las proteínas, los antioxidantes y los micronutrientes clave implicados en el metabolismo proteico ejercieron un efecto principal sobre la calidad de vida de los pacientes. Dada la prevalencia de las deficiencias nutricionales, la alteración resultante de la capacidad funcional probablemente comprometa la calidad de vida, por lo que se debe garantizar una nutrición adecuada.

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          Most cited references15

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          EuroQol: the current state of play.

          R. Brooks (1996)
          The EuroQol Group first met in 1987 to test the feasibility of jointly developing a standardised non-disease-specific instrument for describing and valuing health-related quality of life. From the outset the Group has been multi-country, multi-centre, and multi-disciplinary. The EuroQol instrument is intended to complement other forms of quality of life measures, and it has been purposefully developed to generate a cardinal index of health, thus giving it considerable potential for use in economic evaluation. Considerable effort has been invested by the Group in the development and valuation aspects of health status measurement. Earlier work was reported upon in 1990; this paper is a second 'corporate' effort detailing subsequent developments. The concepts underlying the EuroQol framework are explored with particular reference to the generic nature of the instrument. The valuation task is reviewed and some evidence on the methodological requirements for measurement is presented. A number of special issues of considerable interest and concern to the Group are discussed: the modelling of data, the duration of health states and the problems surrounding the state 'dead'. An outline of some of the applications of the EuroQol instrument is presented and a brief commentary on the Group's ongoing programme of work concludes the paper.
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            National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure.

            The National Kidney Foundation Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Renal Failure was recently published in the American Journal of Kidney Diseases. This publication provides 27 clinical practice guidelines for adults and 10 clinical practice guidelines for children. The adult guidelines focus primarily on patients undergoing maintenance dialysis therapy, although there are several clinical practice guidelines on nutritional issues for patients with advanced chronic renal failure (CRF) not undergoing dialysis therapy. The pediatric guidelines focus entirely on children undergoing maintenance dialysis treatment. The present article discusses a number of the more prominent clinical practice guidelines for the adults. Among these is the recommendation that the protein-energy nutritional status in these patients should be assessed by a panel of measures rather than by any single measure. Also, non-dialyzed patients with advanced CRF (ie, glomerular filtration rate /=60 years of age. Maintenance hemodialysis patients should be prescribed 1.2 g protein/kg/d; chronic peritoneal dialysis patients should be prescribed 1.2 to 1.3 g protein/kg/d. For non-dialyzed patients with CRF (glomerular filtration rate <25 mL/min), 0.60 g protein/kg/d should be prescribed. For patients who will not accept such a diet or are unable to maintain an adequate energy intake on that diet, a protein intake of up to 0.75 g protein/kg/d may be prescribed. At least 50% of the protein intake for all of these patients should be of high biologic value. A guideline concerning indications for inaugurating maintenance dialysis treatment or renal transplantation on the basis of deteriorating nutritional status is also given.
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              Energy and protein requirement

              (1985)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                nh
                Nutrición Hospitalaria
                Nutr. Hosp.
                Grupo Arán (Madrid, Madrid, Spain )
                0212-1611
                1699-5198
                April 2006
                : 21
                : 2
                : 139-144
                Affiliations
                [01] Lisbon orgnameUniversity of Lisbon orgdiv1Faculty of Medicine orgdiv2Institute of Molecular Medicine Portugal
                Article
                S0212-16112006000200003
                16734065
                ac47020d-ee4b-491a-bbe7-5dfbfc32ca1f

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 27 June 2005
                : 13 September 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 6
                Product

                SciELO Spain


                Hemodiálisis crónica,Nutrición,Morbilidad,Calidad de vida,Chronic haemodialysis,Nutrition,Morbidity,Quality of life

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