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Néphrologie & Thérapeutique

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Nutritional status of elderly hemodialysis people in Tunisia Volume 17, issue 3, Etats des lieux dans l'HDF en 2022

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Authors

There has been a resurgence in home haemodialysis over the last decade and interest in its implementation in gaining momentum with advances in technology and healthcare policy initiatives. Both increasing haemodialysis frequency and treatment time have several potential benefits in improving dialysis efficiency and are ideally placed in the home setting. The paper describes the rationale, current status, controversies, challenges and future avenues for home haemodialysis.

Nephrotic syndrome is in adult patients mainly due to membranous nephropathy (MN) characterized by thickening of the glomerular basement membrane (GBM) and immune complex formation between podocytes and the GBM. Autoantibodies directed against the M-type phospholipase A2 receptor (PLA2R) and thrombospondin 1 domain-containing 7 A (THSD7A) can be used as diagnostic biomarkers. THSD7A seems to be of direct pathogenic significance as is suggested by experimental models and plasmapheresis in humans. Recently, further antigens like NELL-1 (neural tissue encoding protein with EGF-like repeats-1), exostosin 1 and 2 have been discovered. Thus, MN should be classified into antibody positive and antibody negative MN. More specific immunosuppressive treatments directed against B-cells and antibody production like rituximab have been introduced in addition to already existing immunosuppressive protocols including steroids, chlorambucil, cyclophosphamide, and calcineurin inhibitors. Antibody removal using immunoadsorption or plasmapheresis leads to short-term reduction in proteinuria and might be indicated only in patients with very severe proteinuria and complications. Studies are needed to identify a more specific immunosuppression directed against the production and effects of autoantibodies in order to protect the kidneys from autoimmune mediated tissue damage and to identify patients who require an immunosuppressive treatment, as the remission rate is high in patients with MN.

Introduction

L’état nutritionnel des sujets âgés hémodialysés conditionne leur pronostic. L’objectif de cette étude était d’évaluer les apports alimentaires spontanés des personnes âgées hémodialysées.

Méthodes

Cette étude descriptive transversale a concerné 40 sujets âgés hémodialysés recrutés au service de néphrologie M8 de l’hôpital Charles Nicolle de Tunis. Tous les patients ont bénéficié d’un examen clinique permettant de préciser les mesures anthropométriques, et d’une enquête alimentaire par enregistrement de 3jours successifs permettant d’obtenir un bilan nutritionnel.

Résultats

L’évaluation des apports énergétiques des patients a montré un apport quotidien moyen de 25,3±12,3kcal/kg de poids idéal/j. L’apport énergétique total moyen des patients le jour de dialyse et de non-dialyse était respectivement de 29,7±17,7kcal/kg et de 20,9±6,9kcal/kg, avec une différence statistiquement significative (p=0,001). La ration protidique moyenne était de 0,99±0,57g/kg le jour de non-dialyse. Elle diminuait de façon statistiquement significative (p=0,005) le jour de non-dialyse à 0,73±0,28g/kg. La consommation de phosphore était excessive le jour de dialyse et de non-dialyse respectivement dans 20 et 3 % des cas. La carence d’apport calcique touchait la totalité de la population étudiée le jour de non-dialyse. Seuls 6 % des patients avaient un apport calcique satisfaisant le jour de dialyse.

Conclusion

De multiples erreurs diététiques ont été notées dans notre étude. L’évaluation des apports nutritionnels chez les personnes âgées hémodialysées doit faire partie systématiquement de leur prise en charge.

Introduction

The nutritional status of old hemodialysis patients determines their prognosis. The aim of this study was to evaluate the spontaneous dietary intake of hemodialysis of elderly patients.

Methods

This cross-sectional descriptive study included 40 elderly hemodialysis patients recruited at the M8 nephrology department of Charles Nicolle hospital in Tunis. All patients went through a clinical examination to specify anthropometric measurements and a dietary survey based on food registration for 3 consecutive days to obtain a nutritional assessment.

Results

The evaluation of patients’ energy intake showed an average daily intake of 25.3±12.3kcal/kg of ideal weight/day. The average total energy intake of patients on dialysis and non-dialysis days was 29.7±17.7kcal/kg and 20.9±6.9kcal/kg, respectively, with a statistically significant difference (P=0.001). The average daily protein intake was 0.99±0.57g/kg on the day of no dialysis. It decreased statistically significantly (P=0.005) on the day of no dialysis at 0.73±0.28g/kg. Phosphorus consumption was excessive on dialysis and non-dialysis days respectively in 20% and 3% of cases. Deficiency of calcium intake affected the entire population studied on the day of non-dialysis. Only 6% of patients had a calcium intake satisfactory on the day of dialysis.

Conclusion

A lot of dietary errors were noticed in our study. The assessment of nutritional intake in elderly people with hemodialysis should be part of their management systematically.