کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5572584 1564722 2017 6 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
The role of nutritional assessment and early enteral nutrition for combined pancreas and kidney transplant candidates
ترجمه فارسی عنوان
نقش ارزیابی تغذیه و تغذیه زودرس انتالال برای پانکراس های ترکیبی و نامزد پیوند کلیه
کلمات کلیدی
تغذیه اولیه روده ای؛ پیوند کلیه پانکراس ترکیبی ؛ شاخص توده بدن؛ CIT؛ زمان ایسکمی سرد؛ COD؛ علت مرگ؛ CVA؛ تصادف غده تیروئید؛ DBD؛ اهداکننده بعد از مرگ مغزی؛ DCD؛ اهداکننده پس از مرگ گردش خون؛ EEN
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی مراقبت های ویژه و مراقبتهای ویژه پزشکی
چکیده انگلیسی

SummaryBackgroundEarly post-operative enteral nutrition is an important part of perioperative management and is strongly supported by ESPEN Guidelines. However, there is limited evidence into the use of Early Enteral Nutrition (EEN) after combined Pancreas and Kidney Transplantation (PKT). We know malnutrition in type-1 diabetics with end stage renal failure (ESRF) is a common problem and a significant risk factor. Therefore, we introduced EEN in our patients.MethodWe monitored and recorded nutritional data on 29 PKT recipients who underwent transplantation between Oct 2007 and Jan 2010 without a nutritional assessment or EEN [Monitored Group (MG)] and on 30 PKT recipients between Feb 2010 and Dec 2013 who received a nutritional assessment and EEN (Naso-jejunal feed or oral intake with supplementation, according to their nutritional status) [Fed Group (FG)].The end-point was to assess patients' daily post-transplant nutritional intake. This was calculated as a percentage of estimated nutritional requirements using the Schofield equation with a 25% added stress factor and relevant activity factor. Following a literature search and realistic targets our aim was to reach >60% requirements: achievement of ≥60% energy requirements by day-7 (7d-60%) and at the time of discharge (total-60%) [13,14].ResultsThere was no significant difference between MG and FG patients in cold ischemic time (CIT), recipient-age and donor-age, Length of Stay and donor-creatinine. In contrast, FG patients were less frequently in predialysis status 41.4% vs. 26.7%, p = 0.001; and had higher incidence of BMI <22.5 kg/m2 63.3% vs. 48.3%, p = <0.005.In outcomes, FG patients more frequently achieved a higher average % of nutritional requirements in the first week 39.69% vs. 22.37%, p = <0.005; as well as during whole in-patient stay 57.24% vs. 44.43%, p = <0.005 (Table 3, Figs. 1 and 2). The FG spent a greater proportion during the first week 66.7% vs. 31%, p = <0.005; and of whole their admission 93.3% vs. 75.9%, p = <0.005; meeting more than 60% of nutritional requirements. Most important, the need for parenteral nutrition within the FG was significantly lower, 7.1% vs. 20.7%, p < 0.005 (Table 3).ConclusionOur results show that these patients benefit from planned EEN and receive better nutritional support when compared to the patients managed with the historic, reactive approach to nutritional care. Nutritional intake in the first week as well as during the whole admission was superior in patients receiving active EEN despite a more difficult post-operative course due to higher incidence of re-operations compared to the control group. Also the need for parenteral nutrition was significantly lower in this group.In addition, pre-transplant nutritional assessment is beneficial and accurately highlights those who may be at risk of malnutrition pre and post-operatively.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Clinical Nutrition ESPEN - Volume 17, February 2017, Pages 22-27
نویسندگان
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