title: Nutritional assessment of the critically ill patients with cardiac disease under renal replacement therapy: diagnostic difficulty.
abstract: OBJECTIVE
  Evaluate the nutritional status of patients with cardiac disease and concomitant renal dysfunction requiring renal replacement therapy.
  
  
  METHODS
  Patients with cardiac disease and renal failure receiving renal replacement therapy, admitted to an intensive care unit, were submitted to nutritional evaluation, by use of anthropometric measurements and laboratory data.
  
  
  RESULTS
  We studied 43 patients, mean age 64±15 years, 26 were men. The mean left ventricular ejection fraction was 0.36±0.16. Analysis of anthropometric measurements, based on body mass index disclosed that, 18 patients were normal, 6 were underweight and 19 were overweight or obese. Based on measurement of triceps skinfold thickness, 16 patients were considered normal and 27 had some degree of depletion. Measurements of midarm circumference and midarm muscular circumference showed 41 patients with some degree of depletion. Laboratory data revealed 28 patients with depletion based on albumin levels and 27 with depletion based on lymphocyte count.
  
  
  CONCLUSIONS
  Malnutrition is common in critically ill patients with cardiac disease and renal failure receiving renal replacement therapy. Nutritional assessment based on body mass index did not prove to be a good index for diagnosis of nutritional disorders. The nutritional evaluation must be complemented in order to identify malnutrition and introduce early nutritional support.
authors.affiliation: Unidade Clínica de Terapia Intensiva do Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Maria das Neves
authors.initials: Md
authors.lastname: Jardim
authors.affiliation: Serviço de Nutrição e Dietética do Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Helenice Moreira da
authors.initials: HM
authors.lastname: Costa
authors.affiliation: Unidade Clínica de Terapia Intensiva do Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Liliane
authors.initials: L
authors.lastname: Kopel
authors.affiliation: Departamento de Cardiopneumologia, Faculdade de Medicina, Universidade de São Paulo.
authors.forename: Silvia Gelás
authors.initials: SG
authors.lastname: Lage