Hipercalemia e hiperfosfatemia na doença renal crônica: revisão narrativa da literatura dos aspectos nutricionais e clínicos
Data
2024-06-19
Autores
Iurevich, Bernardo Gamero 
Abreu, Thaís Virgínia Marques
Orientadores
Góes Junior, Miguel Ângelo de
Tipo
Trabalho de conclusão de curso
Título da Revista
ISSN da Revista
Título de Volume
Resumo
O objetivo deste trabalho foi realizar uma revisão narrativa de literatura, para compreender a importância da terapia nutricional e clínica na Doença Renal Crônica (DRC), com foco nas complicações relacionadas ao potássio e ao fósforo, especificamente a hipercalemia e a hiperfosfatemia, visando analisar como a nutrição desempenha um papel crucial no controle da DRC para evitar complicações graves e melhorar a qualidade de vida dos pacientes. Para isto, foram analisados trabalhos da plataforma de dados disponíveis na PUBMED, Scielo, e nas revistas Brazilian Journal of Nephrology e International Journal of Nephrology, considerando-se o período de 2007 a 2023, nas línguas português, espanhol e inglês, onde 41 trabalhos foram finalmente selecionados de um total de 385 pesquisados na literatura. Os resultados mostraram que o consumo de frutas e hortaliças podem melhorar a sensibilidade à insulina, a inflamação e o estresse oxidativo, sendo mais um fator contribuinte para a diminuição de doenças cardiovasculares e infecciosas. Também podem ter um efeito benéfico em pacientes com constipação, acidose metabólica e no controle glicêmico, ajudando no manejo da hipercalemia. Ainda, o preparo das hortaliças também merece atenção. Em alguns casos, é recomendável a cocção em água, desprezando a água após o cozimento. Ainda, no caso da Hiperfosfatemia, os resultados mostraram que a biodisponibilidade do fósforo varia de acordo com a origem dos alimentos. Em alimentos de origem animal, a biodisponibilidade varia de 30% a 86%, em alimentos de origem vegetal varia 10% e em alimentos industrializados (que contêm aditivos químicos a base de fósforo) apresentou alta biodisponibilidade, de 87% a 100%. Foi observado a importância de ajustes dietéticos criteriosos para o tratamento dos pacientes não dialíticos e evitar comprometer a ingestão proteica em pacientes em estágio dialítico da DRC, nos quais os métodos de diálise frequentemente demonstram limitada eficácia na remoção de fósforo e a inclusão equilibrada de leguminosas na alimentação pode ter um impacto positivo no estado nutricional dos pacientes. Finalmente, pode-se concluir em ambas situações que, um acompanhamento guiado por profissionais de saúde de forma individualizada, é essencial para garantir um controle mais eficaz dos níveis de potássio e fósforo, e desta forma, melhorar a qualidade de vida dos pacientes com DRC.
The objective of this work was to conduct a narrative literature review to understand the importance of nutritional and clinical therapy in Chronic Kidney Disease (CKD), focusing on complications related to potassium and phosphorus, specifically hyperkalemia and hyperphosphatemia. The aim was to analyze how nutrition plays a crucial role in CKD management to prevent severe complications and improve patients' quality of life. For this purpose, studies available on the PUBMED, Scielo, and the journals Brazilian Journal of Nephrology and International Journal of Nephrology platforms were analyzed, considering the period from 2007 to 2023, in Portuguese, Spanish, and English, where 41 studies were finally selected from a total of 385 found in the literature. The results showed that the consumption of fruits and vegetables can improve insulin sensitivity, inflammation, and oxidative stress, contributing to the reduction of cardiovascular and infectious diseases. They can also have a beneficial effect on patients with constipation, metabolic acidosis, and glycemic control, helping in the management of hyperkalemia. Additionally, the preparation of vegetables also deserves attention. In some cases, cooking in water and discarding the water after cooking is recommended. Regarding hyperphosphatemia, the results showed that the bioavailability of phosphorus varies according to the food source. In animal-based foods, bioavailability ranges from 30% to 86%, in plant-based foods it varies around 10%, and in processed foods (which contain phosphorus-based chemical additives), it showed high bioavailability, from 87% to 100%. The importance of careful dietary adjustments for the treatment of non-dialysis patients was observed to avoid compromising protein intake in dialysis-stage CKD patients, in whom dialysis methods often demonstrate limited efficacy in phosphorus removal, and the balanced inclusion of legumes in the diet can have a positive impact on the nutritional status of patients. Finally, it can be concluded that, in both situations, individualized follow-up by health professionals is essential to ensure more effective control of potassium and phosphorus levels, thereby improving the quality of life of patients with CKD.
The objective of this work was to conduct a narrative literature review to understand the importance of nutritional and clinical therapy in Chronic Kidney Disease (CKD), focusing on complications related to potassium and phosphorus, specifically hyperkalemia and hyperphosphatemia. The aim was to analyze how nutrition plays a crucial role in CKD management to prevent severe complications and improve patients' quality of life. For this purpose, studies available on the PUBMED, Scielo, and the journals Brazilian Journal of Nephrology and International Journal of Nephrology platforms were analyzed, considering the period from 2007 to 2023, in Portuguese, Spanish, and English, where 41 studies were finally selected from a total of 385 found in the literature. The results showed that the consumption of fruits and vegetables can improve insulin sensitivity, inflammation, and oxidative stress, contributing to the reduction of cardiovascular and infectious diseases. They can also have a beneficial effect on patients with constipation, metabolic acidosis, and glycemic control, helping in the management of hyperkalemia. Additionally, the preparation of vegetables also deserves attention. In some cases, cooking in water and discarding the water after cooking is recommended. Regarding hyperphosphatemia, the results showed that the bioavailability of phosphorus varies according to the food source. In animal-based foods, bioavailability ranges from 30% to 86%, in plant-based foods it varies around 10%, and in processed foods (which contain phosphorus-based chemical additives), it showed high bioavailability, from 87% to 100%. The importance of careful dietary adjustments for the treatment of non-dialysis patients was observed to avoid compromising protein intake in dialysis-stage CKD patients, in whom dialysis methods often demonstrate limited efficacy in phosphorus removal, and the balanced inclusion of legumes in the diet can have a positive impact on the nutritional status of patients. Finally, it can be concluded that, in both situations, individualized follow-up by health professionals is essential to ensure more effective control of potassium and phosphorus levels, thereby improving the quality of life of patients with CKD.
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Citação
IUREVICH, Bernardo Gamero; ABREU, Thaís Virgínia Marques. Hipercalemia e hiperfosfatemia na doença renal crônica: revisão narrativa da literatura dos aspectos nutricionais e clínicos. 2024. 28 f. Trabalho de conclusão de curso (Graduação em Nutrição) - Universidade Federal de São Paulo, Instituto de Saúde e Sociedade, Santos, 2024.