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V sklopu magistrskega dela smo analizirali prehranski status bolnikov s kronično ledvično odpovedjo, ki prihajajo na hemodializno zdravljenje v Univerzitetni Klinični center v Ljubljani. S klinično študijo smo želeli ugotoviti, kako se bolniki prehranjujejo, kakšno kislinsko obremenitev telesa predstavlja njihova prehrana ter kakšna je povezava s telesno sestavo. Na 170 bolnikih smo izvedli bioimpedančne meritve telesne sestave ter ocenili njihov prehranski status s pomočjo vprašalnika MIS (ang. Malnutrition Inflammation Score). Z izbranimi 56 bolniki smo izvedli podroben prehranski intervju ter ocenili fizično pripravljenost s testom stiska pesti in testom vstani-sedi. Kislinsko obremenitev smo ocenili z izračunom PRAL (ang. Potential Renal Acid Load) in NEAP (ang. Estimated Net Endogenous Acid Production). Med 170 bolniki je bil povprečni indeks mišičnega tkiva pri ženskah 11,0 ± 2,3 kg/m2 in pri moških 13,9 ± 3,3 kg/m2. Povprečen delež maščobnega tkiva pri ženskah je bil 36 ± 10 % in pri moških 29 ± 11 %. Povprečen fazni kot pri ženskah je bil 3,7 ± 1,1º in pri moških 4,3 ± 1,2º. Pri izbrani skupini 56 bolnikov je povprečen dnevni energijski vnos znašal 22,6 ± 6,2 kcal/kg tm in povprečen dnevni vnos beljakovin 0,91 ± 0,28 g/kg tm. Povprečen dnevni vnos vlaknin je bil 15,2 ± 5,3 g. Povprečen PRAL je znašal 13,2 ± 9,2 mEq/dan in povprečen NEAP je znašal 68 ± 17 mEq/dan. Povprečen serumski albumin je bil 37,9 ± 5,1 g/L. Glede na rezultate meritev v našem vzorcu lahko zaključimo, da imajo dializni bolniki v povprečju slab prehranski status, kar je posledica pomanjkljivega prehranjevanja, saj bolniki ne zadostijo svojim potrebam po energiji in beljakovinah. Prisotnost energijsko-beljakovinske podhranjenosti dokazujejo tudi nizke vrednosti serumskega albumina ter povprečen indeks mišične mase pod priporočeno vrednostjo. Poleg tega delež maščobne mase nad priporočeno vrednostjo nakazuje na sarkopenično debelost. Glede na rezultate naše raziskave PRAL ni imel vpliva na telesno sestavo, saj na telesno sestavo v prvi vrsti vpliva zadosten vnos energije, beljakovin in vzdrževanje telesne aktivnosti. The aim of the study was to analyse nutritional status of patients with end stage kidney disease who are receiving hemodialysis treatment at the University Clinical Center in Ljubljana. Our goal was to analyse nutritional intake of the patients, dietary acid load of their diet and the relationship with body composition. We performed bioimpedance measurements of body composition and we assessed nutritional status of 170 patients using the MIS (Malnutrition Inflammation Score) questionnaire. With selected group of 56 patients we conducted nutritional interview and assessed their physical fitness level with grip strength test and sit to stand test. Acid load was estimated by calculating PRAL (Potential Renal Acid Load) and NEAP (Estimated Net Endogenous Acid Production). The mean index of muscle tissue in women was 11.0 ± 2.3 kg/m2 and in men 13.9 ± 3.3 kg/m2. The average proportion of adipose tissue in women was 36 ± 10 % and in men 29 ± 11 %. The mean phase angle in women was 3.7 ± 1.1º and in men 4.3 ± 1.2º. The average daily energy intake was 22.6 ± 6.2 kcal/kg bw and the average daily protein intake 0.91 ± 0.28 g/kg bw, the mean daily fibre intake was 15.2 ± 5.3 g. The mean PRAL was 13.2 ± 9.2 mEq/day and the mean NEAP was 68 ± 17 mEq/day. The mean serum albumin was 37.9 ± 5.1 g/L. Based on the results obtained from this study, we can conclude that on average our dialysis patients have poor nutritional status, which is due to unmet needs for energy and protein. The presence of energy-protein malnutrition is also evidenced by low serum albumin values and an average muscle mass index below the recommended value. In addition, the proportion of fat mass above the recommended value indicates sarcopenic obesity. According to the results of our study, PRAL had no effect on body composition, presumably because the body composition is primarily affected by adequate energy intake, protein and maintenance of physical activity.

Prehrana in telesna aktivnost sta pomembni pri zdravljenju kronične odpovedi ledvic. Zaradi omejitvene diete in pomanjkanja apetita kot tudi slabe telesne pripravljenosti, se bolniki gibljejo premalo in jedo slabo. Cilj dela je bil s spletnim orodjem natančno analizirati prehrano bolnikov na peritonealni dializi. Primerjali smo vnos hranil s podatki o sestavi telesa, pridobljenimi z bioimpedančnimi meritvami ter z rezultati laboratorijske analize krvi, ki se redno kontrolira med zdravljenjem. S preprostimi testi fizične pripravljenosti, kot je stisk roke ter sedi, vstani test, smo opredelili preiskovančevo telesno zmogljivost in jo primerjali s prehranskim statusom. V raziskavo smo vključili 19 bolnikov na peritonealni dializi. Povprečni energijski vnos vseh 19 bolnikov znaša (1545 ± 295) kcal/dan, povprečni beljakovinski vnos znaša (0,8) g/kg telesne mase/dan, povprečni vnos fosforja znaša (0,8 ± 0,2) g/dan, povprečni vnos kalija (1,9 ± 0,5) g/dan. Povprečni ITM (indeks telesne mase) je (24,4 ± 2,9 kg/m2), povprečni fazni kot, ki predstavlja intaktnost celične membrane, je (5,2 ± 0,9), povprečni LTI (indeks pustega telesnega tkiva) je (14,5 ± 2,8 kg/m2), povprečni FTI (indeks maščobnega telesnega tkiva) je (9,3 ± 3,6 kg/m2). Vnos energije in beljakovin je v povprečju nižji od priporočenih vrednosti za dializne bolnike. Vnos fosforja in kalija ne presega mejnih vrednosti. Rezultati merjenja moči stiska roke kažejo na slabo zmogljivost zgornjih okončin. Bolniki na peritonealni dializi imajo zaradi zahtevnih priporočil težave pri izbiri ustreznih živil in samem prehranjevanju, zaradi pomanjkanja volje in energije pa je stopnja telesne dejavnosti nizka. S kombinacijo ocene fizične zmogljivosti in ocene jedilnika pričakujemo diagnostiko njihovih prehranskih problemov. S primernimi ukrepi bi prispevali k izboljšanju rezultatov zdravljenja in tudi kvalitete življenja teh bolnikov. A proper nutritional approach and regular physical activity are important to improve the quality of life and to maintain physical ability in renal patients treated with peritoneal dialysis. Physical inactivity and poor nutritional status are common in renal patients, because of the restrictive diet, appetite loss and poor physical fitness. The aim of this clinical study was to analyse dietary intake of 19 patients. We compared the dietary intake with their body composition, measured with bio impendance spectroscopy. With simple tests such as hand grip test and sit to stand test, we assesed the patients physical ability and compared the results with their nutritional status. Average caloric intake of 19 patients is 1545 ± 295 kcal/day, or 21,4 kcal/kg body weight /day, average protein intake is 0,8 g/kg body weight/day, average phosphorus intake is 0,8 ± 0,2 g/day and average potassium intake is 1,9 ± 0,5 g/day. Average BMI (body mass index) is 24,4 ± 2,9 kg/m2, average phase angle is 5,2 ± 0,9, average LTI (lean tissue index) is 14,5 ± 2,8 kg/m2 and average FTI (fat tissue index) is 9,3 ± 3,6 kg/m2. Average energy intake and protein intake is inadequate according to the dietary recommendations for patients treated with peritoneal dialysis. Average phosphorus intake and potassium intake corresponds to the recommendations. The results of the hand grip test showed hand grip weakness and reduced muscle strenght among observed patients. Patients report a lack of motivation and energy, which are associated with low levels of physical activity. The results of this study will help us diagnose our patients nutritional status, so we can find suitable measurements to ensure the proper rehabilitation and improve our patients quality of life.

Redno spremljanje prehranskega statusa dializnih bolnikov je bistveno za doseganje optimalne prehranjenosti in preprečevanja beljakovinsko energijske podhranjenosti. Cilj magistrskega dela je bil analizirati prehranski vnos dializnih bolnikov in ugotoviti, če ustreza njihovim potrebam. Še posebej smo se osredotočili na vnos beljakovin. Klinična študija je bila izvedena na 30 naključno izbranih dializnih pacientih v dializnem centru Univerzitetnega Kliničnega centra v Ljubljani. Prehranski intervju smo izvedli petkrat v obdobju treh mesecev z metodo jedilnika prejšnjega dne in slikovnim gradivom za oceno velikosti porcij. Rezultate smo analizirali s spletnim orodjem Prodi 6.6 Expert. Vsem bolnikom je bila izmerjena sestava telesa z bioimpedančno spektroskopijo. Povprečni energijski vnos 30 pacientov znaša (14,1 ± 4,7) kcal/kg TM (telesne mase)/dan, povprečni beljakovinski vnos znaša (0,61 ± 0,19) g/kg TM/dan. Povprečni ITM (indeks telesne mase) je (27,9 ± 4,4) kg/m2, povprečni LTI (indeks pustega telesnega tkiva) je (12,5 ± 3,1) kg/m2, povprečni FTI (indeks maščobnega tkiva) je (14,2 ± 5,7) kg/m2 in povprečni fazni kot je (4,2 ± 1,0). Povprečni energijski vnos in vnos beljakovin sta glede na priporočila neustrezna. Vnos opazovanih mikro-hranil (K, P, Na) ustreza priporočilom. Rezultati antropometričnih meritev nakazujejo sarkopenično debelost. Glede na cilj raziskave smo potrdili, da sta energijski in beljakovinski vnos dializnih bolnikov neustrezna glede na njihove potrebe. Glede na rezultate prehranske analize in bioimpedančnih meritev smo med obravnavanimi pacienti potrdili prisotnost energijsko beljakovinske podhranjenosti. Regular assessment of nutritional status of dialysis patients is vital for preventing malnutrition and protein energy wasting. The aim of this clinical study was to analyze dietary intake of dialysis patients and to determine if it meets their nutritional needs. In particular, we focused on protein intake. Clinical study was conducted on 30 randomly selected dialysis patients in the dialysis department of the University Medical Centre Ljubljana. Nutritional interview was conducted unannounced five times over a period of three months with the 24-hour recall method. Results were analyzed with Prodi 6.6 Expert software. Body composition was measured with bio impedance spectroscopy. Average caloric intake of 30 patients is 14.1 ± 4.7 kcal/kg body weight per day, average protein intake is 0.61 ± 0.19 g/kg body weight per day. The average BMI (body mass index) is 27.9 ± 4.4 kg/m2, the average LTI (lean tissue index) is 12.5 ± 3.1 kg/m2, the average FTI (fat tissue index) is 14.2 ± 5.7 kg/m2 and the average phase angle is 4.2 ± 1.0. Average calorie intake and protein intake are inadequate according to the dietary recommendations for dialysis patients. The intake of analyzed micro-nutrients (K, P, Na) corresponds to the recommendations for dialysis patients. Anthropometric measurements indicate sarcopenic obesity. According to the aim of the study, we confirmed that caloric and protein intake of dialysis patients are inadequate according to their needs. Depending on the results of nutritional analysis and bio impedance measurements, we have confirmed the presence of protein energy wasting among observed patients.