Protein-Energy Malnutrition and Its Progression in Dialysis Patients in West Delhi Centre: A Prospective Study

Abstract

Background: There is a high prevalence of protein-energy malnutrition in patients with chronic renal failure who are undergoing maintenance hemodialysis. Apart from this the pathogenic mechanisms of malnutrition are complex and involve an interplay of multiple pathophysiologic alterations including decreased appetite, decreased nutrient intake and dialysis related abnormalities. Methods: The study subjects were patients of CKD 5 (MHD) of age 18 to 60 years enrolled from Anjuman Medical centre in West Delhi. Total 30 subjects (15 males and 15 females) were enrolled from Dialysis centre and their basic demographic profile socio economic status, dietary habits and physical activity details were recorded. Dietary nutrient (calories, protein, fats, carbohydrates, sodium, potassium, phosphorus and fluid) was calculated by Diet Cal version 10.0 software using a 3-day dietary recall and analysed was done using SPSS software version 21.0. Nutritional status were measured at baseline , 2 months and 3 months. Knowledge, Attitude, practice and Quality of life also recorded at 1 month and at 3 months after nutritional counselling. Results: The average BMI, weight, and height of males were (24.2 kg/m2, 67.6 kg, and 166 cm) and females were (22.2 kg/m2, 54.8 kg, and 158 cm) respectively. Blood pressure was 129±13 systolic and 79±10 mmHg diastolic. 23.3% had pallor, and 60% of patients were moderate and 33.3% were severely malnutrition. Handgrip was 21.7±6.9 kg. Protein intake changed from 52±15.9 to 73.2±11.4 in males and 47.8±50.4 to 57.0±13.7g in females after three months of the study. And energy improved from 1477±333 to 2253±494 in males and 1201±255 to 2106±346 kcal in females. Similarly, fat and phosphorus intake improved from 49.2±37.9 to 56.5±17.9 (p>0.080) and 728.9±287.7 to 1160.0±290.1 (p>0.000) respectively. While KAP was (8.5±2.0, 75.3±10.6 and 25.8±2.3) respectively and QoL also improved from 27.0±4.0 to 30.9±2.7 after 3 months of the study. Conclusion: After 3 months of study, QoL and KAP significantly improved. Further, there were significant changes in intake of energy, protein and phosphorus in all dialysis patients. In nutritional status weight, MUAC and handgrip showed significant increase result. Blood pressure, pallor and MIS score also improved.