An integrative approach to detect protein–energy wasting among chronic kidney disease maintenance hemodialysis patients

Abstract

<br><b>Background:</b> Malnutrition is a major predictor of overall outcome in patients on hemodialysis. Regular and frequent evaluation of the nutritional status of these patients is advisable. <b>Aims and Objectives:</b> This study aimed to look at nutritional status of a hemodialysis cohort and to evaluate whether multiple assessment tools improve the detection of malnutrition in this cohort. <b>Materials and Methods:</b> A prospective study in two outpatient hemodialysis centers was conducted over 6 months. Stable patients without any irreversible organ damage and preserved cognitive function were included in the study. Data collected included demographics, comorbid conditions, and baseline laboratory investigations. The nutritional assessment tools included body mass index (BMI), 7-point Subjective Global Assessment, Global Leadership In Malnutrition (GLIM), handgrip strength, and body composition analysis. <b>Results:</b> A total of 121 subjects (77 males, 44 females) participated in the study. Based on BMI, only 14% were underweight. 7-point SGA detected 77 malnourished subjects, whereas according to GLIM criteria, all patients had some degree of malnutrition. Body composition analysis showed depleted total body protein mass in majority of patients. There was a correlation between total body protein mass and handgrip strength. The assessment tools showed some degree of correlation in patients who were malnourished. <b>Conclusions:</b> Use of a single assessment tool often underdiagnoses malnutrition in hemodialysis patients. An integrative approach using multiple evaluation tools may be beneficial in these groups of patients.<br>