Associação entre estado nutricional, composição corporal e marcadores laboratoriais com a taxa de filtração glomerular estimada em indivíduos adultos com anemia falciforme

Abstract

The sickle cell disease (SCD) is the term used to designate group of genetic changes characterized by the presence of abnormal hemoglobin S (HbS). There are different genotypes on SCD individuals, being the homozygous for the genes of HbS the form known as sickle cell anemia (SCA). Changes on glomerular filtration rate (GFR) are frequently observed on SCA individuals, once the medullary portion of the kidney presents several conditions that lead to the sickling of the red blood cells .However, the factors contributing to the changes on GFR on this population is still unknown. Therefore, the present study aimed to evaluate whether the nutritional status, body composition and laboratorial markers is associated with the estimated GFR in adults with SCA. This is an observational and cross-sectional study comprised by individuals of both genders, aged greater than or equal to 19 and lower than 60 years old. The nutritional status was assessed by objectives methods (anthropometry, dual energy X-ray absorptiometry (DXA) and 24-hour food recall) and subjective (7 points subjective global assessment (SGA-7p)). The visceral adipose tissue (VAT) analysis was assessed by DXA. The laboratorial analysis were assessed in order to evaluate the hematologic profile , including hemolysis marker and the renal function. The renal function was evaluated by the estimated GFR (eGFR) by the EPI-CKD equation. Glomerular hyperfiltration was considered when eGFR were > 120 mL/min/1,73m2, while chronic kidney disease (CKD) was considered when eGFR was < 60 mL/min/1,73m2. Values of p < 0.05 were considered to be statistically significant. Forty-two adults with SCA with mean age of 39 ±12.4 years were included in the study. The prevalence of glomerular hyperfiltration was of 50% (n=21), while 19% (n=8) had CKD. The eGFR was significantly associated with age, SGA-7p, body fat, VAT, energy intake, red blood cells, reticulocytes and urea. In the multiple regression analysis, which included the log of eGFR was the dependent variable and the red blood cell, reticulocytes and VAT percentage as the independent variables, in addition to age and gender, it was observed that the age (β=-0.014; p=0.009), reticulocytes counting (β=0.08; p=0.013) and VAT percentage (β=0.05; p=0.013) were associated with eGFR. In conclusion our results showed that VAT percentage was associated with the increase on eGFR in SCA individuals, suggesting that abdominal obesity is a factor, in addition to those linked to the SCA, likely to lead to an increase in GFR in this sample