[Nutritional outcome of uremic diabetic patients: preliminary results from the prospective follow-up of Bordeaux's cohort].
Diabetologists and nephrologists must cooperate to improve uraemic diabetic patient's outcome, with a special attention to their nutritional status. We describe the management of these patients at the CHU of Bordeaux since 2001, and its first results. Renal function is assessed by the glomerular filtration rate, predicted by the Cockcroft-Gault formula according to clinical guidelines. We compared its results to reference isotopic measurements (51Cr-EDTA) in one hundred and twenty two patients. This comparaison showed clearly a bias because the GFR calculated by the formula is proportionnal to body weight: the prediction is overestimated by 55% in obese (BMI > 30) and 15% in overweighted (25 < BMI < 30) patients, who represent the majority of type 2 diabetic patients; the MDRD equation is not affected by this bias. Nutritional follow-up is based on body composition assessment by DEXA, but more simple methods (Skinfold thickness, bio-impedancemetry) have given similar results in our first forty nine patients. After 2 years of follow-up, no patient have lost fat or fat-free mass, except seven patients who have lost 6 kg fat-free mass during the 6 months after starting hemodialysis. The kind of this fat-free mass loss (muscular loss, or correction of hyperhydratation) remains a matter of discussion.
Raffaitin
Christelle
C
Service de diabétologie, hôpital Haut-Levêque-USN, avenue de Magellan 33604 Pessac, France.
Lasseur
Catherine
C
Gin
Henri
H
Combe
Christian
C
Rigalleau
Vincent
V
D000293:Adolescent; D000328:Adult; D003928:Diabetic Nephropathies / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009747:Nutritional Physiological Phenomena; D011446:Prospective Studies; D014511:Uremia / Q000503:physiopathology / Q000628:therapy*