Índice de massa corporal e suas implicações na capacidade funcional, risco de sarcopenia e marcadores inflamatórios de pacientes em hemodiálise

Abstract

Introduction: Chronic kidney disease (CKD) is a condition in which there is a progressive loss of kidney function, leading to complications and impacting patients' quality of life. The global increase in the number of CKD cases has led to an increase in hemodialysis (HD), which is associated with complications such as nutritional disorders, reduced functional capacity (HR), and chronic inflammation. Objective: To evaluate body mass index (BMI) and its implications for HR, risk of sarcopenia and inflammation markers in HD patients. Methodology: This is a cross-sectional study that was carried out with HD patients in the nephrology centers of Hospital Veredas, Unirim, Hospital Memorial Arthur Ramos and Hospital do Coração. A socioeconomic questionnaire standardized by the research group was applied; nutritional assessment performed (weight, height, BMI, calf conditions) and tests to assess the risk of sarcopenia (SARC-F and SARC-CALF) and functional capacity (gait speed and dynamometry). Finally, blood was collected to measure the cytokines interleukin 1 beta (IL-1beta), IL-6 and tumor necrosis factor alpha (TNF-α). Patients were categorized by BMI (underweight, eutrophic and overweight) to perform statistical analyses. Results: The initial sample consisted of 124 participants, the majority of whom were adults 52.7% (n=78) with a mean age of approximately 46.6 years (SD?). Regarding BMI, 41.7% (n=40) of participants were overweight, while 16.7% (n=14) were underweight. The risk of sarcopenia found by SARC-F was 20.4% (n=19), while by SARC-Calf it was 32.6% (n=30). Patients classified as eutrophic and overweight did not differ for TNF-α (p>0.05), however underweight individuals had higher levels of this cytokine than eutrophic individuals (p<0.05). Finally, a negative view was observed regarding the dialysis adequacy index, indicating that, as BMI increases, Kt/V tends to decrease, which may indicate less dialysis adequacy in patients with higher BMI. Conclusion: The study demonstrated that excess weight is also present in the population undergoing hemodialysis treatment, however underweight still seems to be more unfavorable. In relation to CF, the gait speed parameter proved to be superior to HGS in assessing the patient's inadequacy. In this study, malnourished people were more inflamed.