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Redna analiza prehranskega vnosa hemodializnih bolnikov je pomembna za ohranjanje optimalnega prehranskega statusa. Ob pričetku zdravljenja s hemodializo se potrebe po beljakovinah povečajo, medtem ko se omejitve fosfata, kalija in natrija še vedno priporočajo z namenom preventive presnovnih zapletov. Cilj raziskave je bil ugotoviti, ali med pacienti s slabim in dobrim prehranskim statusom obstajajo razlike v prehranskem vnosu ter ali je prehranski vnos zadosten glede na priporočila. Klinično študijo smo izvedli v hemodializnem centru Univerzitetnega kliničnega centra v Ljubljani. Raziskava je potekala v dveh delih. Najprej smo 170 hemodializnim pacientom izmerili sestavo telesa in jim ocenili prehranski status z vidika podhranjenosti in vnetja z vprašalnikom MIS (ang. Malnutrition Inflammation Score). Nato smo izbrali po 28 pacientov z najboljšo in najslabšo oceno MIS in z njimi izvedli prehranski intervju ter ocenili telesno pripravljenost. Zanimal nas je vnos beljakovin, fosforja in kalija, saj so pri tej populaciji pogosto prisotne beljakovinsko energijska podhranjenost, hiperfosfatemija in hiperkalemija. Med skupinama pacientov s slabim in dobrim prehranskim statusom obstajajo statistično značilne razlike v prehranskem vnosu vseh preučevanih parametrov (makrohranila, mikrohranila – P, K, Ca, Na vnos soli, prehranske vlaknine, sadja in zelenjave). Povprečni vnos energije in beljakovin je v obeh skupinah nezadosten glede na priporočene vrednosti. Korelacije med zaužitim fosforjem s hrano in serumskim fosforjem v krvi ni. Korelacije med zaužitim kalijem s hrano in serumskim kalijem v krvi ni. Rezultati bioimpedančnih meritev, prehranske analize in nizke vrednosti serumskega albumina potrjujejo prisotnost beljakovinsko energijske podhranjenosti. Hemodializni pacienti nujno potrebujejo prehransko svetovanje, saj brez njega ne morejo doseči prehranskih ciljev potrebnih za podporo zdravljenja. Regular analysis of the nutritional intake of hemodialysis patients is important to maintain optimal nutritional status. At the start of hemodialysis treatment, protein requirements increase, while phosphate, potassium and sodium restrictions are still recommended to prevent metabolic complications. The aim of the research was to determine whether there are differences in dietary intake between patients with poor and good nutritional status and whether dietary intake is sufficient according to recommendations. The clinical study was conducted in the hemodialysis center of the University clinical center in Ljubljana. The research was conducted in two parts. First, we measured the body composition of 170 hemodialysis patients and assessed their nutritional status in terms of malnutrition and inflammation using the MIS (Malnutrition Inflammation Score) questionnaire. We then selected 28 patients with the lowest and highest MIS score and conducted a nutritional interview and assessed their physical fitness. We were interested in protein, phosphorus and potassium intake, as protein-energy malnutrition, hyperphosphatemia and hyperkalemia are often present in this population. Between the groups of patients with poor and good nutritional status, there are statistically significant differences in the dietary intake of all studied parameters (macronutrients, micronutrients – P, K, Ca, Na intake of salt, fiber, fruit and vegetables). The average intake of energy and protein in both groups is insufficient according to the recommended values. There is no correlation between dietary phosphorus intake and blood serum phosphorus or between dietary potassium intake and blood serum potassium. The results of bioimpedance measurements, nutritional analysis and low serum albumin values confirm the presence of protein-energy malnutrition. Hemodialysis patients urgently need nutritional counseling, because without it they cannot achieve the nutritional goals necessary to support the treatment.

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.