Assessment of Factors Related to Diminished Appetite in Hemodialysis Patients with a New Adapted and Validated Questionnaire.

Elihud Salazar-Robles,Lilian E Bosques-Brugada,Claudia Lerma,Armando Ibarra,Abel Lerma,Martín Calderón-Juárez,Héctor Pérez-Grovas,Luis A Bermúdez-Aceves

doi:10.3390/nu13041371

Abstract

Appetite loss is a common phenomenon in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (HD). We aimed to (i) adapt and validate a Spanish language version of the Council on Nutrition Appetite Questionnaire (CNAQ) and (ii) to identify psychological and biological factors associated with diminished appetite. We recruited 242 patients undergoing HD from four hemodialysis centers to validate the Spanish-translated version of the CNAQ. In another set of 182 patients from three HD centers, the Appetite and Diet Assessment Tool (ADAT) was used as the gold standard to identify a cut-off value for diminished appetite in our adapted questionnaire. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Distorted Thoughts Scale (DTS), Dialysis Malnutrition Score (DMS), anthropometric, values and laboratory values were also measured. Seven items were preserved in the adapted appetite questionnaire, with two factors associated with flavor and gastric fullness (Cronbach’s alpha = 0.758). Diminished appetite was identified with a cut-off value ≤25 points (sensitivity 73%, specificity 77%). Patients with diminished appetite had a higher proportion of females and DMS punctuation, lower plasmatic level of creatinine, blood urea nitrogen, and phosphorus. Appetite score correlated with BDI score, BAI score and DTS. Conclusions: This simple but robust appetite score adequately discriminates against patients with diminished appetite. Screening and treatment of psychological conditions may be useful to increase appetite and the nutritional status of these patients.

Highlights

Appetite loss is a common phenomenon in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (HD) [1] and is a remarkable cause of protein
The study included adult patients from three HD units located in two regions of Mexico: 242 patients who were enrolled for the validation of the appetite questionnaire and 182 patients who were enrolled for the analysis of factors related to low appetite
We focused on decreased appetite levels, as they pose a threat to the health of patients undergoing HD

Summary

Introduction

Appetite loss is a common phenomenon in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (HD) [1] and is a remarkable cause of protein–. Appetite loss is associated with symptoms of depression and anxiety [3], high concentrations of pro-inflammatory cytokines [4,5], hospitalization [6], diminished quality of life [7], and increased mortality [8]. Despite the high prevalence of nutritional disorders, there is not a standard method to assess appetite loss. The Appetite and Diet Assessment Tool (ADAT) is a nutrition-specific instrument [9] that has been used to measure anorexia prevalence in patients on hemodialysis [10]. A poor score is associated with adverse clinical outcomes such as hospitalization and risk of death [6]

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