The prevalence of malnutrition and the relationship with dietary compliance in patients with end stage renal disease

Abstract

The relatively high incidence of malnutrition and resulting increased morbidity and mortality among patients with end stage renal disease (ESRD) is well documented. The rigidity and complexity of the renal diet may contribute to “hyperdietism” resulting in inadequate dietary intake. The purpose of this study was to describe the prevalence of malnutrition in ESRD patients referred for renal transplantation and describe any association with the degree of dietary compliance. Biochemical and anthropometric data was collected on 200 patients. A 24 hour dietary recall and food frequency were completed. The degree of dietary compliance was measured subjectively based on definitions described previously (Camel, CRNQ, 1990). The study group consisted of 128 males and 72 females with a mean age of 43 ± 13 (range 17–70). Ninety percent of the patients were dialysis dependent (76% hemodialysis/14% peritoneal dialysis). Of the total group, 96% were found to have one or more sub-optimal nutrition indices. Fifty-one percent of the patients presented with sub-optimal visceral and/or somatic protein stores as measured by albumin (<2.8 mg/dl), transferrin (<200 mg/dl) and mid arm muscle area (MAMA) (<15th percentile). The extent of energy malnutrition was less remarkable with 15% of the patients falling below the 15th percentile for triceps skin fold (TSF) and 8% below 85% ideal body weight (IBW). Good dietary compliance was demonstrated by 23% of the patients, which is consistent with previously reported rates. Moderate compliance was demonstrated by 37%, fair by 58%, and poor by 9%. There is a significant negative correlation between the degree of compliance and serum transferrin (p<0.05) suggesting that the more compliant the patient is the lower the transferrin. This trend persisted with albumin, Fe, MAMA, TSF, and percent IBW although not statistically significant. Patients demonstrating good compliance had a significantly lower albumin, transferrin, MAMA, and TSF when compared to those with poor compliance (p<0.05). Dietary education for protein repletion was required by 34% of the patients compared to 12% of all others. In conclusion, this study confirms the high prevalence of protein malnutrition in patients with ESRD and suggests that patients demonstrating good compliance with the renal diet are at greater risk of malnutrition. Perhaps our educational focus should be shifted from renal diet restrictions, which may perpetuate “hyperdietism” towards greater emphasis on the provision of optimal nutrition.