Simple methods for nutritional status assessment in patients treated with repeated hemodialysis

Abstract

Protein-energy malnutrition is common in chronic hemodialysis patients and is strongly associated with increased morbidity and mortality. While determination of the nutritional status is often based on objective measurements such as biochemical parameters and anthropometric measurements, there is no single measurement that can reliably identify risk for malnutrition. A subjective global assessment (SGA) was performed to evaluate the nutritional status in 43 chronic dialysis patients (27 men and 16 women). Anthropometric measurements including body weight (BW), body mass index (BMI), skin-fold thickness (triceps-TS, biceps-BS, subscapular-SSS, suprailiac-SIS), midarm circumference (MAC); mid-arm muscle circumference (MAMC); body fat percentage (%BF); total body fat (TBF); lean body mass (LBM) and laboratory parameters (total proteins, albumins, transferrin, hemoglobin, lymphocytes. According to SGA, patients were divided into three groups: first group of 23 pts with a normal nutritional status, second group of 11 pts with mild malnutrition and third group of 9 pts with moderate or severe malnutrition. In examined groups there was a significant decrease in total protein (p = 0.02), serum albumin (p = 0.000) and hemoglobin (p = 0.04) levels with an increase in SGA scores (oneway ANOVA). In the same way, SGA was correlated with the number of anthropometric parameters (BW, BMI, TS, SSS, SIS, MAC, MAMC, % BF, TBF, LBM). Our data confirmed a high prevalence of malnutrition in hemodialysis patients and showed that SGA closely correlated with more objective measures. Being an inexpensive method of well-proven realibility, SGA can be recommended for a more frequent assessment of nutritional status in dialysis patients.