Abstract
The method capable of best identifying protein-energy wasting (PEW) in hemodialysis (HD) patients is controversial. Thus, we assessed the nutritional status of HD patients by use of different methods and verified which one identified the highest number of patients with PEW. The study assessed the nutritional status of 15 HD patients (age: 52.7 ± 10.1 years; males: 33.3%) by use of anthropometric measurements, subjective global assessment (SGA), serum albumin, and dietary intake (24-hour food recall). Body fat was assessed by use of anthropometry. The International Society of Renal Nutrition and Metabolism (ISRNM) criteria were used to diagnose PEW. The body mass index (24.2 ± 4.4 kg/m²) and the percentage of standard value for mid-arm muscle circumference were within the normal limits (102.6 ± 13%). Nevertheless, the percentage of standard value for triceps skinfold was below the normal limits (females, 75.3 ± 40.4%; and males, 73.5 ± 20.6%), although a high body fat percentage was observed (females, 34.5 ± 7.3%; males, 23.6 ± 4.2%). When assessing the nutritional status by use of SGA, most patients (80%, n = 12) were malnourished, and SGA was the method that identified the highest number of patients with PEW. By using the ISRNM criteria, PEW was diagnosed in only two patients. All patients were diagnosed with PEW by use of one of the methods studied. The SGA was the method that, in isolation, could detect the greatest number of patients with PEW.
Highlights
The method capable of best identifying protein-energy wasting (PEW) in hemodialysis (HD) patients is controversial
Other causes of PEW are as follows: low dietary energy and protein intake; loss of nutrients and amino acids through the dialysate; muscle catabolism induced by dialysis itself and by metabolic acidosis; the increased energy expenditure that occurs during HD and within the two hours following the procedure; resistance to insulin and anabolic hormones, such as growth hormone; oxidative stress and inflammation.[3]
The percentages of the standard values for TSF, arm circumference (AC), and Midarm muscle circumference (MAMC) were obtained by use of the reference table adapted by Blackburn & Thornton (1979).[13]
Summary
The method capable of best identifying protein-energy wasting (PEW) in hemodialysis (HD) patients is controversial. We assessed the nutritional status of HD patients by use of different methods and verified which one identified the highest number of patients with PEW. When assessing the nutritional status by use of SGA, most patients (80%, n = 12) were malnourished, and SGA was the method that identified the highest number of patients with PEW. Because of that high prevalence of PEW in HD, nutritional assessment should be performed to identify the risks and/or causes of deterioration of the nutritional status, and to establish a nutritional diagnosis. This will allow the establishment of nutritional goals to prevent and/or treat PEW.[4]
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