Nutritional assessment in patients with chronic renal failure under hemodialysis
Abstract
Introduction: Several factors involved in the development of malnutrition in Hemodialysis patients, given the impact of malnutrition in the forecast, it is extremely important to monitor the protein energy status of these patients. Objective: 10 assess the nutritional status of patients with chronic kidney disease (ERC5) stage 5 on hemodialysis (HD). Methods: Patients over 18 years, of both sexes, tri-weekly dialysis. Nutritional diagnosis was used as the Subjective Global Assessment (SGA), body mass index (BMI), triceps skinfold (PT), arm muscle circumference (AMC), and biochemical parameters (alburnin, cholesterol, protein catabolic rate, phosphorus). Results: According to SGA, 5% of patients had reiterate malnutrition by BMI 28% had malnutrition, according to the PT showed 12% depletion of their fat mass and was significantly higher in females (p = 0.015). According to the AMC showed 42% depletion of their muscle mass and was significantly higher in males (p = 0.029). According to the values of albumin, 41% were at nutritional risk and cholesterol levels by 55%. The 75% had inadequate protein intake. AMC depletion was significantly correlated with low protein intake (p = 0.02). 62% of the population showed altered phosphorus values. Conclusions: From this study it appears that no single method of nutritional assessment and need a combination of subjective and objective methods in order to identify those patients who require specific nutritional interventions.
References
Feinstein EI, Kopple JD. Severe wasting and malnutrition in a patient undergoing maintenance dialysis. Am J Nephrol. 1985;5(5):398-405.
Thunberg BJ, Swamy AP, Cestero RV. Cross-sectional and longitudinal nutritional measurements in maintenance hemodialysis patients. Am J Clin Nutr. 1981;34(10):2005-12.
Rocco MV, Paranandi L, Burrowes JD, Cockram DB, Dwyer JT, Kusek JW, et al. Nutritional status in the HEMO Study cohort at baseline. Hemodialysis. Am J Kidney Dis. 2002;39(2):245-56.
Rodríguez Ramos N, Ortega Formoso YL, Díaz Hernández R, Ramos Ramos AM, Rodríguez Llanusa RO. Evaluación nutricional y su repercusión en la capacidad funcional: Hemodiálisis, Hospital General "Abel Santamaría Cuadrado". Rev Cienc Méd. 2010;14(1):178-89.
Fouque D, Vennegoor M, Ter Wee P, Wanner C, Basci A, Canaud B, et al. EBPG guideline on nutrition. Nephrol Dial Transplant. 2007;22(Suppl 2):45-87.
Laville M, Fouque D. Nutritional aspects in hemodialysis. Kidney Int Suppl. 2000;76:S133-9.
Schulman G. The dose of dialysis in hemodialysis patients: impact on nutrition. Semin Dial. 2004;17(6):479-88.
Ahuja TS, Mitch WE. The evidence against malnutrition as a prominent problem for chronic dialysis patients. Semin Dial. 2004;17(6):427-31.
Kopple JD. Pathophysiology of protein-energy wasting in chronic renal failure. J Nutr. 1999;129(1S Suppl):247S-251S.
NKF-DOQI clinical practice guidelines for hemodialysis adequacy. National Kidney Foundation. Am J Kidney Dis. 1997;30(3 Suppl 2):S15-66.
Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. 1981;34(11):2540-5.
Aparicio M, Cano N, Chauveau P, Azar R, Canaud B, Flory A, et al. Nutritional status of haemodialysis patients: a French national cooperative study. French Study Group for Nutrition in Dialysis. Nephrol Dial Transplant. 1999;14(7):1679-86.
Allen KL, Miskulin D, Yan G, Dwyer JT, Frydrych A, Leung J, et al. Association of nutritional markers with physical and mental health status in prevalent hemodialysis patients from the HEMO study. J Ren Nutr. 2002;12(3):160-9.
Dwyer JT, Larive B, Leung J, Rocco M, Burrowes JD, Chumlea WC, et al. Nutritional status affects quality of life in Hemodialysis (HEMO) Study patients at baseline. J Ren Nutr. 2002;12(4):213-23.
Kopple JD, Zhu X, Lew NL, Lowrie EG. Body weight-for-height relationships predict mortality in maintenance hemodialysis patients. Kidney Int. 1999;56(3):1136-48.
Abbott KC, Glanton CW, Trespalacios FC, Oliver DK, Ortiz MI, Agodoa LY, et al. Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. Kidney Int. 2004;65(2):597-605.
Jones CH, Wolfenden RC, Wells LM. Is subjective global assessment a reliable measure of nutritional status in hemodialysis? J Ren Nutr. 2004;14(1):26-30.
Cooper BA, Bartlett LH, Aslani A, Allen BJ, Ibels LS, Pollock CA. Validity of subjective global assessment as a nutritional marker in end-stage renal disease. Am J Kidney Dis. 2002;40(1):126-32.
Visser R, Dekker FW, Boeschoten EW, Stevens P, Krediet RT. Reliability of the 7-point subjective global assessment scale in assessing nutritional status of dialysis patients. Adv Perit Dial. 1999;15:222-5.
Lawson JA, Lazarus R, Kelly JJ. Prevalence and prognostic significance of malnutrition in chronic renal insufficiency. J Ren Nutr. 2001;11(1):16-22.
Enia G, Sicuso C, Alati G, Zoccali C. Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant. 1993;8(10):1094-8.
Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol. 1996;7(2):198-207.
Port FK, Pisoni RL, Bragg-Gresham JL, Satayathum SS, Young EW, Wolfe RA, et al. DOPPS estimates of patient life years attributable to modifiable hemodialysis practices in the United States. Blood Purif. 2004;22(1):175-80.
De Mutsert R, Grootendorst DC, Boeschoten EW, Brandts H, Van Manen JG, Krediet RT, et al. Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients. Am J Clin Nutr. 2009;89(3):787-93.
Marcén R, Lamas S, Quereda C, Orofino L, Teruel JL, Ortuño J. Morbidity in hemodyalisis patients: relationship between serum urea and nutricional status. En: Friedman E. Prevention of progressive uremia. Philadelfia: Field & Wood, 1990, p. 189-93.
Molina A, Sánchez E, Terroba C, De Paula A, Rodrigo A, Plagaro E, et al. Estudio nutricional de pacientes en hemodiálisis periódica. Nefrología (Madr.) 1994;14(Supl 2):64-72.
García Álvarez ML, Arranz Pérez I, Roldán Sánchez MA, Velázquez Coca C, Millán Galante M, Bernal Porcel P. Valoración del estado nutricional de los pacientes en nuestra unidad de hemodiálisis. Prevalencia de malnutrición. Enferm Nefrol. 2003;6(3):27-30.
Martin CJ, Reams SM. The renal dietitian's role in managing hyperphosphatemia and secondary hyperparathyroidism in dialysis patients: a national survey. J Ren Nutr. 2003;13(2):133-6.
Noordzij M, Korevaar JC, Dekker FW, Boeschoten EW, Bos WJ, Krediet RT, et al. Mineral metabolism and mortality in dialysis patients: a reassessment of the K/DOQI guideline. Blood Purif. 2008;26(3):231-7.
Canaud B, Garred LJ, Argiles A, Flavier JL, Bouloux C, Mion C. Creatinine kinetic modelling: a simple and reliable tool for the assessment of protein nutritional status in haemodialysis patients. Nephrol Dial Transplant. 1995;10(8):1405-10.
