Zusammenfassung
Hintergrund
Das Auftreten einer Malnutrition bei Dialysepatienten geht mit erhöhter Morbidität und Mortalität einher. Die Therapie einer Mangelernährung bleibt jedoch häufig erfolglos, was durch mangelndes Verständnis des Patienten für die Notwendigkeit einer diätetischen Intervention bedingt sein könnte. Wir untersuchten in dieser Studie, inwieweit die Beurteilung der Ernährung durch Patienten und Arzt übereinstimmt.
Patienten und Methode
Bei 68 chronischen Dialysepatienten wurde der Ernährungsstatus mittels „Subjective Global Assessment” (SGA) erhoben. Im Serum wurden Albumin, Präalbumin, Transferrin und Cholesterin bestimmt, zusätzlich wurde die „Protein-Catabolic-Rate” (nPCR) ermittelt. Mittels Fragebogen wurden die Patienten um eine Beurteilung ihrer Ernährung und ihres Gewichtes gebeten.
Ergebnis
Nach SGA-Kriterien zeigten 34% der Patienten Zeichen der mäßigen bis schweren Malnutrition, bei 45% lag das Serumalbumin < 4,0 g/dl. Albumin korrelierte am besten mit der klinischen Beurteilung, wohingegen Transferrin, Präalbumin, Cholesterin und Protein-Catabolic-Rate schlechtere Korrelationen zeigten. Der Fragebogen wurde von 85% der Patienten beantwortet. In der nach SGA-Kriterien mangelernährten Gruppe beurteilten 84% die eigene Ernährung als „ausreichend”, 79% waren mit dem eigenen Gewicht zufrieden, lediglich 21% beklagten Untergewicht.
Schlußfolgerung
Unsere Untersuchung zeigt, daß bei Hämodialysepatienten häufig eine Fehlbeurteilung der eigenen Ernährungssituation vorliegt. Dies sollte bei der Beratung und Führung mangelernährter Patienten berücksichtigt werden.
Summary
Background
Malnutrition in hemodialysis patients is associated with increased mortality and morbidity. Interventions to treat malnutrition are often ineffective. Underestimation by the patients of the importance of dietary interventions might negatively influence any therapeutic outcome. We examined the correlation between nutritional assessment by the patient himself and clinical assessment by the physician.
Patients and Methods
Subjective global assessment (SGA) was performed in 68 chronic hemodialysis patients. Serum concentrations of albumin, prealbumin, transferrin and cholesterin were measured. Protein intake was estimated by protein catabolic rate (nPCR). In form of a questionaire patients were asked to assess their own nutrition.
Results
According to SGA-criteria, moderate to severe malnutrition was found in 34% of our patients. In this malnourished group serum albumin was <4.0 g/dl in 45% of patients and correlated best with clinical nutritional assessment. Specificity was lower for prealbumin, transferrin, cholesterin, and nPCR. The questionaire was completed by 85% of patients. Self-assessment of their own nutrition was discrepant to clinicla assessment in 84% of malnourished patients. A similar percentage (79%) of malnourished patients considered their own body weight to be adequate, while only 21% indicated desire to gain weight.
Conclusions
Our data indicate that a significant percentage of malnourished hemodialysis patients shows a tendency to overestimate their own nutrition. This may negatively influence patient compliance and should be considered in dietary counseling of malnourished chronic hemodialysis patients.
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Kuhlmann, M.K., Winkelspecht, B., Hammers, A. et al. Malnutrition bei Hämodialysepatienten. Med. Klin. 92, 13–17 (1997). https://doi.org/10.1007/BF03042276
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DOI: https://doi.org/10.1007/BF03042276