Kronik Böbrek Hastalığı ve Son Dönem Böbrek Hastalığı’nda Malnütrisyon Pankreatik Ekzokrin Disfonksiyon ile İlişkili Olabilir mi?

Year 2018, , 20 - 25, 01.04.2018

Bülent Huddam Alper Azak Özgür Demirhan Nilüfer Bayraktar Volkan Karakuş , Yelda Dere Siren Sezer

https://doi.org/10.5505/kjms.2018.74317

Abstract

Amaç: Kronik böbrek hastalığı (KBH) ilişkili malnutrisyon ile pankreatik ekzokrin disfonksiyon arasındaki ilişki henüz net olarak açıklanamamıştır. Böbrek hastalıklarında pankreatik ekzokrin disfonksiyona ilişkin literatür yeterli değildir. Bu çalışmanın amacı böyle bir ilişkinin olup olmadığının araştırılmasıdır. 
Materyal ve Metot: 40 SDBH, 40 KBH ve 42 sağlıklı gönüllünün dahil edildiği çalışmada katılımcıların beslenme durumlarının belirlenmesi amacıyla “Kısa Nütrisyonel Değerlendirme (KND)” formu doldurulmuş ve pankreasın ekzokrin işlevlerinin belirlenmesi için fekal elastaz 1 (FE1) düzeyleri ölçülmüştür. 
Bulgular: Kontrol grubunda FE1 düzeyleri KBH ve SDBH ggruplarına göre anlamlı derecede yüksek bulunmuştur. FE1’in pankreas ekzokrin fonksiyonunu göstermedeki duyarlılığı göz önüne alındığında, sonuçlar böbrek hastalarında kötü pankreatik ekzokrin fonksiyonunu işaret etmektedir. 
Sonuç: Böbrek hastalığında malnutrisyonun çok farklı nedenleri olabilmesinin yanı sıra, pankreatik ekzokrin disfonksiyon bu nedenlerden biri olarak düşünülebilir. FE1 düzeyleri pankreasın ekzokrin fonksiyonunun belirlenmesinde kullanılabilir.

Keywords

malnutrisyon, kronik böbrek hastalığı, pankreatik ekzokrin disfonksiyon; fekal elastaz 1

Is There Any Contribution of Pancreatic Exocrine Dysfunction to the Malnutrition in Chronic Kidney Disease and End Stage Renal Disease?

Abstract

Aim: Pancreatic exocrine dysfunction has many causes and often results in malnutrition. The relationship between chronic renal disease related malnutrition and pancreatic exocrine function has not been understood clearly yet. There is lack of data in the literature regarding pancreas exocrine dysfunction in kidney diseases. This study aimed to show whether existence of this relationship. 
Material and Method: 40 End stage renal disease (ESRD) patients, 40 chronic renal disease (CKD) patients and 42 healthy volunteers without any diagnosed systemic diseases were included. ‘Mini Nutritional Assessment’ (MNA) form has been filled up to determine the nutritional status of the participants. Fecal elastase 1 (FE1) levels measured in order to evaluate the exocrine function of pancreas. 
Results: FE1 values of control group were significantly higher from CKD and ESRD patients both. When considering the sensitivity of FE1 to show pancreas exocrine function, these results worsen pancreas exocrine function in patients with kidney disease. 
Conclusion: Malnutrition in kidney diseases has various reasons, and pancreatic exocrine dysfunction thought to be one of them. FE1 levels may be used in order to evaluate the exocrine functions of the pancreas.

Keywords

malnutrition, chronic kidney disease, pancreas exocrine dysfunction; fecal elastase 1

References

• 1. U S Renal Data System, USRDS 2010 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2010.
• 2. Marckmann P. Nutritional status of patients on hemodialysis and peritoneal dialysis. Clin Nephrol 1988;29:75–78.
• 3. Enia G, Sicuso C, Alati G, Zoccalli C. Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant 1993;8:1094–1098.
• 4. Cianciaruso B, Brunori G, Kopple JD, Traverso G, Panarello G, Enia G et al. Cross-sectional comparison of malnutrition in continuous ambulatory peritoneal dialysis and hemodialysis patients. Am J Kidney Dis 1995;26:475–486.
• 5. Tyler Stevens, Darwin L Conwell. Pancreatic exocrine function tests. www. uptodate. com. Accessed on 22 February 2012.
• 6. Raslan M, Gonzalez MC, Dias MC, Nascimento M, Castro M, Marques P et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutr 2010;26(7–8):721–726.
• 7. Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T et al. Mini Nutritional Assessment International Group. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010;58(9):1734–1738.
• 8. Leeds JS, Oppong K, Sanders DS. The role of fecal elastase-1 in detecting exocrine pancreatic disease. Nat Rev Gastroenterol Hepatol 2011;8(7):405–415.
• 9. Teichmann J, Riemann JF, Lange U. Prevalence of exocrine pancreatic insufficiency in women with obesity syndrome: assessment by pancreatic fecal elastase 1. ISRN Gastroenterol 2011;2011:951686.
• 10. Griesche-Philippi J, Otto J, Schwörer H, Maisonneuve P, Lankisch PG. Exocrine pancreatic function in patients with end-stage renal disease. Clin Nephrol 2010;74(6):457–464.
• 11. Young GA, Kopple JD, Lindholm B, Vonesh EF, De Vecchi A, Scalamogna A et al. Nutritional assessment of continuous ambulatory peritoneal dialysis patients: An international study. Am J Kidney Dis 1991;17:462–471.
• 12. Dwyer JT, Cunniff PJ, Maroni BJ, Kopple JD, Burrowes JD, Powers SN et al. The hemodialysis pilot study: nutrition program and participant characteristics at baseline. The HEMO Study Group. J Renal Nutr 1998;8:11–20.
• 13. Janardhan V, Soundararajan P, Rani NV, Kannan G, Thennarasu P, Chacko RA et al. Prediction of Malnutrition Using Modified Subjective Global Assessment-dialysis Malnutrition Score in Patients on Hemodialysis. Indian J Pharm Sci 2011;73(1):38–45.
• 14. Tayyem RF, Mrayyan MT. Assessing the prevalence of malnutrition in chronic kidney disease patients in jordan. J Ren Nutr 2008;18(2):202–209.
• 15. Aguilera A, Bajo MA, Espinoza M, Olveira A, Paiva AM, Codoceo R et al. Gastrointestinal and pancreatic function in peritoneal dialysis patients: their relationship with malnutrition and peritoneal membrane abnormalities. Am J Kidney Dis 2003;42(4):787–796.
• 16. Sziegoleit A, Linder D. Studies on the sterol-binding capacity of human pancreatic elastase. Gastroenterol 1991;100:768–774.
• 17. Siegmund E, Löhr JM, Schuff-Werner P. The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis. Z Gastroenterol 2004;42(10):1117–1128.
• 18. Dominici R, Franzini C. Fecal elastase-1 as a test for pancreatic function: a review. Clin Chem Lab Med 2002;40(4):325–332.
• 19. Hardt PD, Marzeion AM, Schnell-Kretschmer H, Wüsten O, Nalop J, Zekorn T et al. Fecal elastase 1 measurement compared with endoscopic retrograde cholangiopancreatography for the diagnosis of chronic pancreatitis. Pancreas 2002;25(1): e6–9.
• 20. Cano DA, Hebrok M, Zenker M. Pancreatic development and disease. Gastroenterol 2007;132:745–762.
• 21. Gorelick F, Pandol SJ, Topazian M. Pancreatic physiology, pathophysiology, acute and chronic pancreatitis. Gastrointestinal Teching Project, Am Gastroenterol Assoc 2003.
• 22. Muench R, Ammann R. Fecal immunoreactive lipase: aterosclerotic new tubeless pancreatic function test. Scand J Gastroenterol 1992;27:289–294.
• 23. Dominiguez-Munz JE, Hieronymus C, Saurerbruch T, Malfertheiner P. Fecal elastase test: evaluation of a new noninvasive pancreatic function test. Am J Gastroenterol 1995;90:1834–1837.
• 24. Loser C, Mollgaard A, Folsch UR. Faecal elastase 1: a novel highly sensitive, and specific tubeless pancreatic function test. Gut 1996;39:580–586.
• 25. Soldan W, Henker V, Sprossig C. Sensitivity and specificity of quantitative determination of pancreatic elastase 1 in feces of children. J Pediatr Gastroenterol Nutr 1997;24:53–55.
• 26. Walkowiak J, Nousia-Arvanitakis S, Lisowska A, Piotrowski R, Strzykala K, Bychowiec B et al. Serum lipase after secretin stimulation detects mild pancreatic involvement in cystic fibrosis. J Pediatr Gastroenterol Nutr 2004;38(4):430–435.
• 27. Jiang CF, Ng KW, Tan SW, Wu CS, Chen HC, Liang CT et al. Serum level of amylase and lipase in various stages of chronic renal insufficiency. Zhonghua Yi Xue Za Zhi (Taipei)2002;65(2):49–54.