Qualidade de vida de pacientes com doença renal em estágio terminal com baixa massa muscular submetidos a hemodiálise

Abstract

Introduction: Chronic kidney disease (CKD) is a heterogeneous disease that affects the structure and function of the kidneys. The literature indicates that low quality of life (QOL) scores are predictors of mortality in individuals undergoing hemodialysis (HD). The QOL of individuals with CKD is directly associated with modifiable factors (among which anemia, nutritional status) and non-modifiable factors (age, gender). The detection and understanding of the influence of inadequate nutritional status (causing loss of strength and muscle mass) on the QOL of patients with CKD submitted to HD is of fundamental importance to assist in the development of prevention and intervention actions appropriate to the needs of these patients (rehabilitation nutritional, functional, psychological and family). Objective: To define a cutoff point for lean tissue to classify low muscle mass in end stage kidney disease in patients undergoing HD, and based on this cut-off point compare the QOL level between patients with normal muscle mass and low muscle mass. Methods: We studied 245 patients with end-stage renal disease in HD at the two dialysis centers located in the north region of Ceará state, Brazil, in April 2017. Demographic, clinical and laboratory data were collected. Patients’ QOL was assessed by the brazilian version of the Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36). Bioimpedance analysis and handgrip testing were used, respectively, to evaluate muscle mass and muscle strength. Low muscle mass was classified according to muscle strength, and the QOL dimensions were compared between patients with normal and low muscle mass. The dimensions that differed in the comparison were analyzed, along with muscle mass, as dependent variables in a linear regression model to detect independent predictors of QOL scores. Results and Discussion: According to a cut-off point ≤ 15 kg / m² of lean tissue index to classify low muscle mass, a prevalence of 41.2% of low muscle mass was found. Patients with low muscle mass had lower scores related to physical functioning, vitality and mental health. In the multivariate linear regression, the low muscle mass could only predict independently the score related to physical functioning. Conclusion: Low muscle mass affects the physical functioning of patients with end-stage renal disease submitted to HD. It was thought that resistance exercises should be tried among patients in HD with the objective of improving the quality of life.