Relação entre ângulo de fase e inflamação em pacientes renais crônicos submetidos à hemodiálise

Abstract

Introduction: The relationship between inflammatory status and anthropometric parameters has been evaluated in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD), aiming at the interpretation of the clinical-nutritional condition and therapeutic interventions. Inflammation has been linked to malnutrition and atherosclerosis, and this link has led to the description of the MIA syndrome (malnutrition-inflammation-atherosclerosis). The phase angle (AF), derived from the analysis of bioelectrical impedance, is considered an indicator of cell membrane integrity and a predictor of survival in some clinical situations, and has been investigated as a prognostic marker in the assessment of nutritional status, inflammation and mortality. Objectives: To evaluate the relationship between phase angle and inflammatory status in patients with CKD undergoing HD. Methods: Cross-sectional study with 204 CKD patients undergoing hemodialysis in the city of São Luís-MA. The assessment of nutritional status was performed considering different nutritional indicators: body mass index (BMI), skin folds, waist circumference (WC) and bioelectrical impedance analysis (BIA). The AF was determined from the reactance and resistance measurements obtained by the BIA. The ultra-sensitive C-reactive protein (CRP) was used to determine the patients' inflammatory state. To compare the averages of the CRP levels, according to the AF tertiles, the ANOVA or Kruskal-Wallis test was used. The level of significance adopted was 5%. The multiple linear regression model was used to assess the relationship between PA and CRP level. Results: The mean age was 51.9 ± 15.5 years, with a majority of males (59.8%) and mean time on hemodialysis of 4.0 ± 3.5 years. Arterial hypertension (37.3%) was the most common underlying disease for CKD, followed by diabetes mellitus (18.7%). The mean BMI in the study sample was 23.7 ± 4.2 kg / m², mean reactance 63.8 ± 23.5, mean resistance 632.8 ± 113.8 and mean value of phase angle 5.7 ± 1, 5. The median serum hs-CRP level was 0.29 mg / L (0.03 - 10.76 mg / L). Patients with lower PA values showed more advanced age, lower handshake strength, albumin, creatinine values and significantly higher values for levels and CRP-us (p <0.05). In the adjusted analysis, CRP levels were negatively associated with AF (β = -0.237, p = 0.028) and CB (β = -0.172; p = 0.010). Conclusion: In this study, a negative correlation was observed between measurements of phase angle and altered levels of CRP, which may demonstrate a reduction in muscle mass motivated by inflammation in this population.