FACTORS PREDICTING MALNUTRITION IN HEMODIALYSIS-PATIENTS - A CROSS-SECTIONAL STUDY

Citation
Ar. Qureshi et al., FACTORS PREDICTING MALNUTRITION IN HEMODIALYSIS-PATIENTS - A CROSS-SECTIONAL STUDY, Kidney international, 53(3), 1998, pp. 773-782
Citations number
58
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Urology & Nephrology
Journal title
ISSN journal
0085-2538
Volume
53
Issue
3
Year of publication
1998
Pages
773 - 782
Database
ISI
SICI code
0085-2538(1998)53:3<773:FPMIH->2.0.ZU;2-H
Abstract
Signs of protein-energy malnutrition are common in maintenance hemodia lyis (HD) patients and are associated with increased morbidity and mor tality. To evaluate the nutritional status and relationship between va rious parameters used for assessing malnutrition, we performed a cross -sectional study in 128 unselected patients treated with hemodialysis (HD) thrice weekly for at least two weeks. Global nutritional status w as evaluated by the subjective global nutritional assessment (SGNA). B ody weight, skinfold thicknesses converted into % body fat mass (BFM), mid-arm muscle circumference, hand-grip strength and several laborato ry values, including serum albumin (S-Alb), plasma insulinlike growth factor I (p-IGF-I), serum C-reactive protein (S-CRP) and plasma free a mino acids, were recorded. Dose of dialysis and protein equivalence of nitrogen appearance (nPNA) were evaluated by urea kinetic modeling. T he patients were subdivided into three groups based on SGNA: group I, normal nutritional status (36%); group II, mild malnutrition (51%); an d group III, moderate or (in 2 cases) severe malnutrition (13%). Clini cal factors associated with malnutrition were: high age, presence of c ardiovascular disease and diabetes mellitus. nPNA and Kt/V-urea were s imilar in the three groups. However, when normalized to desirable body wt, both were lower in groups II and III than in group I. Anthropomet ric factors associated with malnutrition were low body wt, skinfold th ickness, mid-arm muscle circumference (MAMC), and hand-grip strength. Biochemical factors associated with malnutrition were low serum levels of albumin and creatinine and low plasma levels of insulinlike growth factor 1 (IGF-1) and branched-chain amino acids (isoleucine, leucine and valine). The serum albumin (S-Alb) level was not only a predictor of nutritional status, but was independently influenced by age, sex an d S-CRP. Plasma IGF-1 levels also reflected the presence and severity of malnutrition and appeared to be more closely associated than S-Alb with anthropometric and biochemical indices of somatic protein mass. E levated S-CRP (> 20 mg/liter), which mainly reflected the presence of infection/inflammation and was associated with hypoalbuminemia, was mo re common in malnourished patients than in patients with normal nutrit ional status, and also more common in elderly than in younger patients . Plasma amino acid levels, with the possible exception of the branche d-chain amino acids (isoleucine, leucine, valine), seem to be poor pre dictors of nutritional status in hemodialysis patients.