May Serum Creatine Kınase (CK) Level Be a Malnutrition Parameter In Patients Wıth End-Stage Kidney Failure?

Yıl 2020, Cilt: 4 Sayı: 2, 137 - 143, 12.07.2020

Ahmet Peker , Harun Akar , Mehmet Tanrısev

https://doi.org/10.30565/medalanya.679570

Öz

Aim: The aim of this study was to investigate the relationship between serum CK levels and malnutrition parameters in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) for end stage renal disease (ESRD).

Methods: In this prospective study, 60 patients receiving HD and 30 patients receiving PD for ESRD were evaluated. The relationship between serum CK levels and Mini Nutritional Assessment (MNA) Test scores, albumin, C-Reactive Protein (CRP), arterial blood gas parameters, KT / V ratio, total body water, muscle mass, body mass index (BMI) and lean body mass (determined by Bioelectrical Impedance Analysis (BIA) were examined.

Results: No correlation was found between CK levels and age, dialysis duration and Ca values in HD and PD patients (p> 0.05). A positive correlation was found between CK levels and MNA scores and triceps skinfold thickness, lean body mass, body muscle mass and BMI values of PD and HD patients, and a significant negative correlation between total body water values (p <0.001).

Conclusions: It was determined that serum CK level was compatible with other parameters used in the determination and follow-up of nutritional disorder and sarcopenia in ESRD patients. 

Anahtar Kelimeler

End-Stage Renal Disease, Bioelectrical Impedance, Creatine Kinase, , Sarcopenia, , Malnutrition

Son Dönem Böbrek Yetmezliği Hastalarinda Serum Kreatin Kinaz (Ck) Düzeyi Malnutrisyon Parametresi Olabilir Mi?

Öz

Amaç: Bu çalışmanın amacı; Son Dönem Böbrek Yetmezliği (SDBY) nedeniyle hemodiyaliz (HD) ve periton diyalizi (PD) tedavisi alan hastalarda serum CK düzeyleri ile malnutrisyon parametreleri arasındaki ilişkiyi incelemektir.

Gereç ve Yöntem: Prospektif olarak yürütülen bu çalışmada, Türkiye’ nin Ege bölgesinde hizmet veren bir hastanede SDBY nedeniyle HD tedavisi alan 60 hasta ve PD tedavisi alan 30 hasta değerlendirildi. Hastaların serum CK düzeyi ile Mini Nutrisyonel Değerlendirme Testi (MND)’ nden aldıkları puanlar, albumin ve C-Reaktif Protein (CRP) gibi biokimyasal parametreler, arteriyel kan gazı değerleri, KT/V oranı, Biyoelektriksel İmpedans Analiz (BİA) yöntemiyle bakılan total vücut suyu, kas kütlesi, vücut kitle indeksi (VKİ) yağsız vücut kütlesi ve VYO (vücut yağ oranı) gibi değişkenler arasındaki ilişki incelendi.

Bulgular: HD ve PD hastalarında CK düzeyleri ile yaş, diyaliz süresi ve Ca değerleri arasında ilişki saptanmadı (p>0,05). HD ve PD hastalarının CK düzeyleri ve MND puanları ile BİA parametrelerinden yağsız vücut kütlesi, vücut kas kütlesi ve VKİ değerleri arasında pozitif yönde, TVS değerleri arasında negatif ilişki saptandı (p<0,001).

Sonuç: SDBY hastalarında serum CK düzeyinin, beslenme bozukluğu ve sarkopeninin belirlenmesi ve takibinde kullanılan diğer parametreler ile uyumlu olduğu görülmektedir. 

Anahtar Kelimeler

Son Dönem Böbrek Hastalığı, Biyoelektriksel Empedans, Kreatin Kinaz, Sarkopeni, Malnütrisyon

Kaynakça

• 1. Levey AS, Coresh J, Bolton K, Culleton B, Harvey KS, Ikizler TA et al. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. American Journal of Kidney Diseases. 2002;9;39(2 SUPPL. 1):i-ii+S1-S266.
• 2. Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005;67:2089-100. DOI: 10.1111/j.1523-1755.2005.00365.x
• 3. Caimi G, Carollo C, Presti RL. Pathophysiological and clinical aspects of malnutrition in chronic renal failure. Nutrition research reviews. 2005;18(1):89-97. DOI: 10.1079/NRR200599
• 4. Öztürk GZ, Toprak D. The relationship between glomerular filtration rate, nutrition and activities of daily living in patients with chronic kidney disease receiving homecare. Progress in Nutrition, 2019;21.1:135-140. DOI: 10.23751/pn.v21i1.6704
• 5. Kızıl M, Tengilimoğlu-Metin M, Gümüş D, Sevim S, Türkoğlu İ, & Mandiroğlu F. Dietary inflammatory index is associated with serum C-reactive protein and protein energy wasting in hemodialysis patients: A cross-sectional study. Nutrition research and practice, 2016;10(4):404-410. DOI: 10.4162/nrp.2016.10.4.404
• 6. Barbosa-Silva, Maria Cristina G., et al. "Can bioelectrical impedance analysis identify malnutrition in preoperative nutrition assessment?" Nutrition, 2003;19(5):422-426. DOI: 10.1016/S0899-9007(02)00932-2
• 7. Guigoz Y. The Mini Nutritional Assessment (MNA®) review of the literature-what does it tell us? Journal of Nutrition Health and Aging. 2006;10(6):466-487.
• 8. Flahault A, Metzger M, Chasse JF, Haymann JP, Boffa JJ, Flamant M, Vrtovsnik F, Houillier P, Stengel B, Thervet E, Pallet N. Low serum creatine kinase level predicts mortality in patients with a chronic kidney disease. PloS one. 2016;11(6):e0156433. DOI: 10.1371/journal.pone.0156433
• 9. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet. 2012;380(9859):2197-2223. DOI: 10.1016/S0140-6736(12)61689-4
• 10. Persson MD, Brismar KE, Katzarski KS, Nordenstrom J, Cederholm TE. Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients. J Am Geriatr Soc. 2002;50(12):1996-2002. DOI: 10.1046/i.1532-5415.2002.5Q611.x
• 11. Lilamand M, Kelaiditi E, Demougeot L, Rolland Y, Vellas B, Cesari M. The Mini Nutritional Assessment-Short Form and mortality in nursing home residents—Results from the INCUR study. The journal of nutrition, health & aging. 2015;19(4):383-388. DOI:10.1007/s12603-014-0533-1.
• 12. Owen WF, Lowrie EG. C-reactive protein as an outcome predictor for maintenance hemodialysis patients. Kidney Int. 1998;54(2):627-636. DOI: 10.1046/j.1523-1755.1998.00032.x
• 13. Lim VS, Ikizler TA, Raj DS, Flanigan MJ. Does hemodialysis increase protein breakdown? Dissociation between whole-body amino acid turnover and regional muscle kinetics. Journal of the American Society of Nephrology. 2005;16(4):862-8. DOI: 10.1681/ASN.2004080624.
• 14. Hakim RM, Levin N. Malnutrition in hemodialysis patients. American journal of kidney diseases. 1993;21(2):125-37. DOI: 10.1016/S0272-6386(12)81083-3