Subjective Global Assessment in Patients on Maintenance Hemodialysis - A Study from Public Sector Hospital

Abstract

Listen

Translate article

Introduction: Chronic kidney disease (CKD) is a global public health concern that has a significant financial impact on health-care systems. Protein energy malnutrition (PEM) in MHD patients is associated with increased in mortality, reduced quality of life and increases morbidity, hospitalization, and mortality. According to a global meta-analysis of 65 studies from 10 geographical regions, malnutrition is highly prevalent in maintenance hemodialysis (MHD) patients. The gold standard for evaluating the nutritional state of patients with ESKD is total body nitrogen. SGA tool, MIS, mini nutritional assessment (MNA) tool, Health-Related Quality of Life Short Form 36-Index (WHO HRQOL SF 36), and subjective global nutritional assessment are some of the tools that are practical, validated, and affordable questionnaires that can be utilized in the public domain. A combination of anthropometric measurements and nutritional assessment tools is the most effective way to determine nutritional status. Aim: To assess the nutritional status of maintenance hemodialysis patients in a tertiary care centre using the 7 point SGA method. Type of Study: observational study. Study Setting: Tertiary care hospital in south India. Study Population: Patients undergoing maintenance Hemodialysis in our hospital. Results: Total Number of patients included in the study is 68. Mean age is 46.78years with a standard deviation of 11.181years. Male predominance was seen in the study group 72.1% to female patients 27.9%. Hypertension is the most common associated comorbidity 67.6%, followed by Diabetes mellitus 39.7%. Majority of the study group are in the Dialysis vintage group 1-2 years. Male patients have significant association with Malnutrition (P =0.006*). There is no significant correlation with kuppuswamy socio-economic class(P=0.123). There is no significant correlation between dialysis vintage and malnutrition (P=0.35). There was significant association with serum albumin(P<0.001), Body Mass Index (P<0.001), Mid Arm Circumference (P<0.001), Mid Arm Muscle Circumference (P<0.001), Skin Fold Thickness-Triceps (P<0.001). Conclusion: Moderate malnutrition was present in majority of patients 62%. Severe malnutrition was seen in only 0.8% patients. Statistically significant association was noted between anthropometric measurements-BMI, MAMC, MAC, Skin fold thickness and malnourishment. Serum albumin has significant association. Limitations: Small sample size. SGA is subjective assessment, has inter observer variations.