Malnutrition In Hemodialysis Patients Research Articles

#2896 Malnutrition is prevalent in hemodialysis patients—results from Croatian multicenter hemodialysis study

Abstract Background and Aims Malnutrition is a usually observed condition among patients on hemodialysis (HD) and is considered one of studiest indicators of mortality and morbidity. Malnutrition inflammation score (MIS) is associated with inflammation, nutritional status, quality of life, and 5-year prospective mortality. Also, phase angle (PhA) measured by bioelectrical impedance analysis (BIA) has been studied as indicator of nutritional status or muscle function in HD patients and lower PhA was associated with a greater risk of malnutrition. The aims of this study are to analyze the prevalence of malnutrition in hemodialysis (HD) patients in Croatia using MIS, and to assess the association of MIS and PhA with body mass composition, sociodemographic characteristics and laboratory parameters related to HD. Method 166 HD patients aged 68.5 (58.8-76) years, 55 women (33%) and 111 (67%) men with mean HD duration of 4 (2-6) years from 6 HD center were included in this study. For each study participant, data about body composition measured with BIA, laboratory, sociodemographic and clinical parameters were obtained. Also, body mass index (BMI) was calculated, and the Malnutrition Inflammation Score (MIS) used to assess nutritional status. Results Using an MIS cut-off point of 5 for malnutrition, 53% of patients were malnourished (MIS≥5). Therefore, those malnourished HD patients were significantly older (p = 0.001), with longer HD duration (p = 0.002), lower residual renal function (p = 0.02), waist circumference (p = 0.001), BMI (p < 0.001), muscle (p = 0.002) and fat mass (p = 0.001) in kg, phase angle PhA (p < 0.001), serum creatinine (p = 0.002), albumin (p = 0.008), phosphate (p = 0.01), and urate (p = 0.008) level but have significantly higher ferritin (p = 0.004), and mean cellular volume level (p = 0.02). Therefore, total MIS score significantly negatively correlated with HD duration (r = −0.247, p < 0.001), waist circumference (r = −0.323, p < 0.001),muscle mass (r = −0.236, p < 0.001), fat mass (r = −0.352, p < 0.001), serum creatinine (r = −0.271, p < 0.001), phosphor (r = −0.245, p < 0.001), urate (r = −0.344, p < 0.001), and TIBC (r = −0.376, p < 0.001), albumin (r = 0.241, p < 0.001), ferritin (r = 0.273, p < 0.001). In contrast, PhA significantly positively correlated with muscle mass (kg) (r = 0.311, p < 0.001), creatinine (r = 0.313, p < 0.001), phosphate (r = 0.208, p = 0.01), urate (r = 0.305, p = 0.01) and Total Iron Binding Capacity (TIBC) (r = 0.245, p < 0.001) while significantly negative correlation with ferritin (r = −0.182, p = 0.03) was found. Also, there was a significant negative correlation between PhA and MIS (r = −0.362, p < 0.001). A multivariate regression analysis showed that age (ß = 0.09, p = 0.005), waist circumference (ß = −0.09, p = 0.004), serum albumin (ß = −0.23, p = 0.04), and urate (ß = −0.01, p = 0.02), were predictive factors for malnutrition. Conclusion The prevalence of malnutrition in HD patients in Croatian HD population was high. These results indicate and highlight the urgent need for individualized and structural nutritional screening (using MIS score and PhA) and nutritional support in Croatian HD patients, especially for older HD patients and those with longer HD duration.

Relationship between altered taste and smell with malnutrition among hemodialysis patients.

Alterations in taste and smell are among the most distressing symptoms experienced by haemodialysis patients. There is limited research on the relationship between these two symptoms and malnutrition in haemodialysis patients. This study aimed to investigate alterations in taste and smell in hemodialysis patients and their relationship with malnutrition. This cross-sectional study was carried out with 149 hemodialysis patients at the dialysis centers of three state hospitals. The Taste and Smell Dysfunction Questionnaire was used to assess the changes in patients' taste and smell, and the Prognostic Nutritional Index (PNI), as well as the Controlling Nutritional Status (CONUT) tool, were utilized to evaluate their nutritional status. A substantial percentage (45.6%) of patients reported an altered sense of smell, and 40.2% reported an altered sense of taste. The aspect of taste that was most abnormal was bitterness (46.7%); 53.0% of the patients were at moderate risk of malnutrition by PNI score, and 14.8% were categorized as malnourished by CONUT score. Malnutrition was related to dialysis vintage: a 1-year increase in vintage was associated with an increased risk of malnutrition (OR: 1.17, 95% CI 1.02-1.32, p < 0.001). Altered taste was associated with malnutrition: one-unit increase in the standard deviation of the taste subdimension score was associated with a relative risk of malnutrition (OR: 6.89, 95% CI 1.67-28.39, p < 0.001). A one-unit increase in the standard deviation of the smell subdimension was associated with relative risk of malnutrition (OR: 1.35, 95% CI 1.10-1.64, p < 0.001). Malnutrition was found in a significantpercentage of hemodialysis patients. Altered taste and smell and the durationof dialysis treatment were significantly associated with malnutrition scores It isrecommended that healthcare professionals regularly assess alterations in tasteand smell in hemodialysis patients, as these alterations may be associated withmalnutrition, and manage these alterations accordingly.

Dietary acid load and markers of malnutrition, inflammation, and oxidative stress in hemodialysis patients.

The present study was conducted to examine the association between dietary acid load (DAL) and markers of inflammation, oxidative stress, and malnutrition in a group of Iranian hemodialysis (HD) patients. This cross-sectional study was performed on individuals aged ≥18 years who were on HD at least 6 months before their enrollment in the study. A 4-day dietary recall was used for the evaluation of dietary intake. DAL was calculated using two methods including potential renal acid load (PRAL) and net endogenous acid production (NEAP). For assessing the malnutrition status, we used the subjective global assessment (SGA), dialysis malnutrition score (DMS), and malnutrition inflammation score (MIS). Fasting blood samples were collected from each participant to assess serum levels of high-sensitivity C-reactive protein (hs-CRP), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular adhesion molecule-1 (sVCAM-1), sE-selectin, malondialdehyde (MDA), nitric oxide (NO), and endothelin-1. In total, 291 patients with a mean age of 57.73 ± 0.88 years and HD vintage of 4.27 ± 0.25 months were enrolled in the current study. Significant positive associations were observed between PRAL and hs-CRP (β = 1.77, 95% CI: 0.88, 2.65), sICAM-1 (β = 83.21, 95% CI: 10.39, 156.04), sVCAM-1 (β = 194.63, 95% CI: 74.68, 314.58), and sE-selectin (β = 6.66, 95% CI: 1.81, 11.50) among participants with the highest PRAL scores, compared to those with the lowest PRAL scores. NEAP was positively correlated with hs-CRP (β = 1.34, 95% CI: 0.46, 2.22), sICAM-1 (β = 88.83, 95% CI: 16.99, 160.67), and MDA (β = 0.35, 95% CI: 0.005, 0.71). Additionally, marginally significant higher odds of SGA (OR = 1.98, 95% CI: 0.95, 4.11) and DMS (OR = 1.94, 95% CI: 0.92, 4.05) were observed in individuals in the third tertile of PRAL vs. the first tertile of PRAL. NEAP had also a marginally significant positive correlation with DMS (OR = 2.01, 95% CI: 0.93, 4.31). This study illustrates that higher consumption of acidic foods is correlated with markers of inflammation, oxidative stress, and malnutrition in HD patients.

The hidden and complex relationship between dietary phosphorus and malnutrition in hemodialysis patients with chronic kidney disease.

Chronic kidney disease (CKD) has always been a complicated global challenge, ranking as the 12th leading cause of death worldwide. Hemodialysis, being one of the most opted renal replacement therapies (RRTs) for patients with end-stage renal disease (ESRD), still possesses some limitations in preventing complications, such as malnutrition and mineral bone disease (CKD-MBD). While efforts have focused on controlling CKD-MBD parameters like calcium and phosphate, less attention has been given to dietary interventions. Moreover, the adoption of low-phosphorus diets for hemodialysis patients is very complex due to potential conflicts with the guideline-recommended high-protein dietary approach. This study sought to investigate the relationship between dietary phosphorus intake and nutritional status in CKD patients undergoing regular hemodialysis. This non-randomized cross-sectional study comprising 88 patients was conducted at the Hemodialysis Unit, RSUD Dr. Soetomo, Surabaya, East Java, using a three-day dietary record in March 2022. Relationships between variables were analyzed using Spearman and ANOVA tests. No significant positive association was found between dietary calcium with corrected calcium levels (p = 0.988; rs = -0.002) and between dietary phosphorus with plasma phosphate levels (p = 0.082; rs = 0.187). However, Spearman's analysis revealed a weak but positive correlation between dietary phosphorus and nutritional status (p = 0.022; rs = 0.215*). Our study highlights a positive relationship between dietary phosphorus and nutritional status among hemodialysis patients, offering insights into potential strategies for optimizing patient care and outcomes.

An Analytical Cross-Sectional Study of Malnutrition in Hemodialysis Patients in Gorgan, Iran, 2020

Background: Malnutrition is relatively common in hemodialysis (HD) patients, which increases the risk of mortality. Seven Point Subjective Global Assessment (7-point SGA) tool is recommended to evaluate and monitor malnutrition in HD patients. The aim of this study was to investigate malnutrition using 7-point SGA in HD patients referred to dialysis centers in Gorgan city (north-eastern of Iran) in 2020. Methods: The nutritional status of 133 HD patients referred to Gorgan city dialysis center in 2020 were assessed using the 7-point SGA tool. Weight, percentage of fat, and muscle mass were measured by Omron BF511. Height was measured using the SECA portable stadiometer. Serum hemoglobin levels were recorded based on the latest recorded routine tests during the last month. A demographic information questionnaire was completed for all individuals. Medications and supplements taken by patients as well as visits by a nutrition consultant and adherence to a special diet were investigated by reviewing the medical file and asking the patient. Results: Out of 133 patients, 43.61% had no malnutrition and 56.39% had moderate malnutrition. The nutrition status was not different regarding gender and education level, but was different regarding household size (P=0.032). Patients with moderate malnutrition were older and had less weight and body mass index (BMI), but there was no statistically significant difference between height, dialysis time span, body fat and muscle mass percentage, and serum hemoglobin concentration. Conclusion: This study showed a considerable rate of malnutrition in HD patients, which should be regarded by clinicians and health policymakers.

The correlation between serum growth differentiation factor 15 and malnutrition in patients with end-stage kidney disease on hemodialysis

Objective Malnutrition commonly occurs in patients undergoing maintenance hemodialysis. Early detection of malnutrition could allow early interventions to prevent later complications. At present, there are not many biomarkers with high predictive value of end-stage kidney disease (ESKD)-related malnutrition, especially for early malnutrition in hemodialysis patients, which needs more in-depth research. Therefore, we performed a cross-sectional study on 97 patients to identify biomarkers for malnutrition in hemodialysis patients. Research Methods & Procedures 7-point subjective global assessment (SGA) was applied to evaluate the nutritional status of patients on hemodialysis. Serum levels of growth differentiation factor 15 (GDF15), albumin, pre-albumin, c-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), hemoglobin, low density lipoprotein-cholesterol, and high density lipoprotein-cholesterol were detected before hemodialysis. Logistic analysis and linear regression were used to analyze the association between GDF15 levels and the SGA score after adjustment for basic characteristics and laboratory findings. Results Among the 97 patients on hemodialysis, 51 had malnutrition (SGA < 6). There was no difference between the malnourished and well nourished (SGA ≥ 6) groups for dialysis duration, cholesterol, CRP, TNF-α, and hemoglobin. The malnutrition group had significantly lower grip strength (p < 0.05). GDF15 levels correlated negatively with the SGA score after adjustment for possible confounding factors [rho (male) = -0.312, rho(female)= -0.437;P(male) = 0.0181, P(female) = 0.005], and might contribute to the malnutritional status, the AUCs of GDF15 for malnutrition was 0.697 (p = 0.011) in male and 0.828 (p < 0.001) in female. Conclusions GDF15 is associated with malnutrition according to the SGA score in patients with ESKD on hemodialysis, suggesting that GDF15 might be involved in the pathogenesis of malnutrition patients with ESKD in this setting. Furthermore, GDF15 is likely to be a potential diagnostic biomarker for malnutrition according to the SGA score.

Fortified synbiotic dessert for improving malnutrition in hemodialysis patients: A randomized, double-blind, controlled trial.

As dysbiosis of gut microbiota is recognized as a major risk factor for malnutrition in hemodialysis (HD) patients, we aimed to assess the effects of fortified synbiotic dessert on malnutrition, oxidative stress, inflammation, and quality of life in patients undergoing hemodialysis. A total of 50 hemodialysis patients were randomized into two groups of intervention and control to consume either 50 g of synbiotic dessert fortified with vitamin D (1000 IU) and calcium (500 mg) (FSD) or 50 g of control dessert (CD) for 8 weeks, respectively. Changes in nutritional status [Subjective Global Assessment (SGA)], anthropometric measures, malondialdehyde (MDA), total antioxidant capacity (TAC), high-sensitivity C-reactive protein (hs-CRP), ferritin, biochemistry [serum albumin, vitamin D, creatinine, blood urea nitrogen (BUN), complete blood count (CBC), and electrolytes], and quality of life were assessed before and at the end of the trial. The SGA scores and serum ferritin levels decreased significantly in the FSD group compared to the control group (p = .01 and p = .03, respectively). Regarding other markers, no statistically significant changes were found comparing the two groups. This novel fortified synbiotic dessert as a functional food may be effective in reducing the severity of malnutrition by improving SGA score in short term in hemodialysis patients. Thus, it is suggested to do further studies to elucidate the possible mechanisms related to the effects of this dessert on microbiota, skeletal muscle mass, and inflammation in HD in long term.

Mapping the global research landscape on malnutrition for patients with chronic kidney disease: a visualization analysis

BackgroundChronic kidney disease (CKD) is seen as a diverse disease and a primary contributor to global mortality. Malnutrition arises within chronic illness, which involves protein energy depletion and inadequate levels of essential nutrients. These factors increase the likelihood of death and the overall impact of the disease on affected individuals. Consequently, this study aims to utilize bibliometric and visual analysis to assess the current state of research, the latest advances and emerging patterns in the fields of CKD and malnutrition.MethodsExtensive research was conducted using the Scopus database, which is the most authoritative database of research publications and citations, to focus on CKD research between 2003 and 2022, as indicated by title and author keywords. Then, within this vast collection of academic publications, a notable subset of articles was exclusively dedicated to investigating the relationship between CKD and malnutrition. Finally, we performed bibliometric analysis and visualization using VOSviewer 1.6.19 and Microsoft Excel 2013.ResultsLarge global research between 2003 and 2022 resulted in 50,588 documents focused on CKD, as indicated by title and author keywords. In this extensive collection of scientific publications, a staggering portion of 823 articles is devoted exclusively to investigating the link between CKD and malnutrition. Further analysis reveals that this body of work consists of 565 articles (68.65%), 221 reviews (26.85%), and 37 miscellaneous entries (4.50%), which encompass letters and editorials. The USA was found to be the most productive country (n = 173; 21.02%), followed by Italy (n = 83; 10.09%), Sweden (n = 56; 6.80%), Brazil (n = 54; 6.56%) and China (n = 51; 6.20%). The most common terms on the map include those related to the topic of (a) malnutrition in hemodialysis patients and predicting factors; terms associated with the (b) impact of malnutrition on cardiovascular risk and complications in CKD patients; and terms related to the (c) dietary protein intake and malnutrition in CKD.ConclusionsThis study is the first of its kind to analyze CKD and malnutrition research using data from Scopus for visualization and network mapping. Recent trends indicate an increasing focus on protein-energy wasting/malnutrition in hemodialysis patients and predicting factors, dietary protein intake, and malnutrition in CKD. These topics have gained significant attention and reflect the latest scientific advances. Intervention studies are crucial to examining diet therapy's impact on patients with stages 1 to 5 CKD. We hope this study will offer researchers, dietitians and nephrologists valuable information.

Malnutrition- inflammation- atherosclerosis (MIA) syndrome associates with periodontitis in end-stage renal disease patients undergoing hemodialysis: a cross-sectional study

Malnutrition-inflammation-atherosclerosis (MIA) syndrome is a significant risk factor for mortality in patients undergoing hemodialysis. This study aimed to investigate the association between MIA syndrome and oral health status in hemodialysis patients. A cross-sectional study was conducted on 254 hemodialysis patients. Comprehensive medical and dental examinations were performed. Three components were included to define MIA syndrome: Geriatric Nutritional Risk Index, serum high-sensitivity C-reactive protein, and history of cardiovascular events as indicators of malnutrition, inflammation, and atherosclerosis, respectively. The association of MIA syndrome components with periodontitis and occlusal support was examined by multiple-ordered logistic regression analysis. Of 254 participants, 188 (74.0%) had at least one component of MIA syndrome. After adjusting for possible confounding factors, severe periodontitis was significantly associated with presence of more components of MIA syndrome (odds ratio [OR]: 2.64, 95% confidence interval [CI], 1.44–4.84, p = 0.002) and inflammation and malnutrition components (OR: 2.47 and 3.46, 95% CI 1.16–5.28 and 1.70–7.05, p = 0.020 and 0.001). On the other hand, occlusal support, evaluated by Eichner index, was not significantly associated with MIA syndrome or any of its components. In conclusion, periodontitis is associated with MIA syndrome, particularly with inflammation and malnutrition in hemodialysis patients, independent of occlusal support.

The Humoral Response to SARS-CoV-2 Vaccine in Hemodialysis Patients Is Correlated with Nutritional Status.

Hemodialysis patients are highly susceptible to poor nutritional status. Our objective was to investigate whether poor nutritional status during mRNA-SARS-CoV-2 vaccination is correlated with impaired vaccine responses. This retrospective study was conducted in two hospital-based dialysis units. The nutritional status of hemodialysis patients was assessed, using a malnutrition inflammation score (MIS) at the time of their first BNT162b2 vaccine dose. One month after the second vaccine dose, we performed a quantitative assessment of antibodies against the spike protein (anti-S1 IgG). A total of 115 hemodialysis patients, with an average age of 72 were enrolled in the study. Among them, 39 (33.9%) were female, and 67 (58.2%) had diabetes mellitus. In 43/115 (37.4%) patients, moderate to severe malnutrition (MIS > 5) was detected. Comparatively, malnourished patients showed a lower log-transformed mean level of anti-S1 IgG compared to those with normal nutrition (2.91 ± 0.83 vs. 3.25 ± 0.72, respectively, p = 0.024). In a multivariable analysis that adjusted for age, sex, and KT/V, the nutritional status assessed by an MIS remained inversely associated with an anti-S1 IgG response [B; -0.066 (-0.117 to -0.015)]. In conclusion, moderate to severe malnutrition in hemodialysis patients is associated with reduced humoral responses to BNT162b2 vaccination.

Nutritional Assessment of Patients on Twice Weekly Maintenance Hemodialysis

Objective: To assess the magnitude of malnutrition in hemodialysis patients in Pakistan and identify contributing factors in order to facilitate timely interventions and improve their quality of life. Methodology: A cross-sectional descriptive study was conducted at the nephrology inpatient department of Fauji Foundation Hospital Rawalpindi from April to September 2021. The study included patients aged 15–60 years, of both genders, who had been on maintenance hemodialysis twice weekly for at least six months. Data was collected by structured performa, which included patients’ demographic details, including age, gender, level of education, and daily income; the cause and duration of CKD; duration and frequency of haemodialysis Malnutrition was assessed using the Malnutrition Inflammation Score (MIS) and categorized as mild, moderate, or severe. Results: Out of the 107 enrolled patients, 90 were included in the analysis. The study revealed that only one-third of the patients had normal nutritional status, while the rest exhibited varying degrees of malnutrition. Severe malnutrition was observed in 20% of the hemodialysis population. Female gender, lower education level, and lower income were strongly associated with severe malnutrition. Conclusion: The study highlights the need to improve literacy, raise awareness about chronic kidney disease (CKD), and enhance the financial status of hemodialysis patients. These interventions can significantly improve outcomes and quality of life in this population. The findings emphasize the importance of identifying high-risk patients early on and implementing appropriate interventions to improve nutritional status and overall well-being.

The Role of the Prognostic Inflammatory and Nutritional Index (PINI) in the Evolution of Patients with Chronic Kidney Disease and Other Pathologies.

Protein-energy loss and inflammation are the main risk factors in the occurrence of complications in hemodialysis patients. The Prognostic Inflammatory and Nutritional Index (PINI) is a simple, inexpensive test to identify the early onset of inflammation and malnutrition in hemodialysis patients, critically ill subjects and those with malignancies. A systemic review of English literature was conducted on the topic published between 1985 and 2022. A focused and sensitive search strategy was applied to the PUBMED database to identify relevant scientific articles in English. Once articles were identified, a detailed quality and bias assessment was performed. Two independent researchers analyzed the detailed data extraction. PINI proved to be a sensitive, powerful, low-cost and simple test. PINI has been useful in assessing evolution and prognostics in clinical care, with values above one being associated with a high risk of mortality and morbidity. It is useful in cases with surgical and postoperative complications, long hospitalization, as well as increased associated expenses. This is the first review of the literature on the above-mentioned topic (PINI) and is a valuable candidate for validating prognosis in patients with different pathologies.

Association between Cognitive Impairment and Malnutrition in Hemodialysis Patients: Two Sides of the Same Coin.

Cognitive impairment and malnutrition are prevalent in patients on hemodialysis (HD), and they negatively affect the outcomes of HD patients. Evidence suggests that cognitive impairment and malnutrition may be associated, but clinical studies to assess this association in HD patients are lacking. The aim of this study was to evaluate the association between cognitive impairment evaluated by the Montreal Cognitive Assessment (MoCA) score and nutritional status evaluated by the malnutrition inflammation score (MIS) in HD patients. We enrolled 84 HD patients (44 males and 40 females; age: 75.8 years (63.5-82.7); HD vintage: 46.0 months (22.1-66.9)). The MISs identified 34 patients (40%) as malnourished; the MoCa scores identified 67 patients (80%) with mild cognitive impairment (MCI). Malnourished patients had a higher prevalence of MCI compared to well-nourished patients (85% vs. 70%; p = 0.014). MoCa score and MIS were negatively correlated (rho:-0.317; p < 0.01). Our data showed a high prevalence of MCI and malnutrition in HD patients. Low MoCA scores characterized patients with high MISs, and malnutrition was a risk factor for MCI. In conclusion, it is plausible that MCI and malnutrition are linked by common sociodemographic, clinical, and biochemical risk factors rather than by a pathophysiological mechanism.

Exploring the Impact of Appetite Alteration on Self-Management and Malnutrition in Maintenance Hemodialysis Patients: A Mixed Methods Research Using the International Classification of Functioning, Disability and Health (ICF) Framework.

Hemodialysis (HD) patients face a common problem of malnutrition due to poor appetite. This study aims to verify the appetite alteration model for malnutrition in HD patients through quantitative data and the International Classification of Functioning, Disability, and Health (ICF) framework. This study uses the Mixed Method-Grounded Theory (MM-GT) method to explore various factors and processes affecting malnutrition in HD patients, create a suitable treatment model, and validate it systematically by combining qualitative and quantitative data and procedures. The demographics and medical histories of 14 patients were collected. Based on the theory, the research design is based on expansion and confirmation sequence. The usefulness and cut-off points of the creatinine index (CI) guidelines for malnutrition in HD patients were linked to significant categories of GT and the domain of ICF. The retrospective CIs for 3 months revealed patients with 3 different levels of appetite status at nutrition assessment and 2 levels of uremic removal. In the same way, different levels of dry mouth, functional support, self-efficacy, and self-management were analyzed. Poor appetite, degree of dryness, and degree of taste change negatively affected CI, while self-management, uremic removal, functional support, and self-efficacy positively affected CI. This study identified and validated the essential components of appetite alteration in HD patients. These MM-GT methods can guide the selection of outcome measurements and facilitate the perspective of a holistic approach to self-management and intervention.

The relationship between nutrition screenings and nutritional status determined by malnutrition in hemodialysis patients

Objective: It is aimed to evaluate the relationship of food consumptions, biochemical blood parameters, and some anthropometrics with the screening tests using in the nutritional status of hemodialysis patients with end stage renal failure. Materials and Methods: The survey were conducted with 110 hemodialysis patients who hospitalized at the Nephrology Clinic in Akdeniz University Hospital. The routine biochemical blood parameters of the patients were analyzed and their anthropometric measurements were performed. The food consumptions were recorded by the dietician and Nutritional Risk Screening 2002 (NRS 2002), Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA)has screening tests using were performed. Results: The average age of the patients participating in the study was 55 ± 19 years. In MUST, 42.7% of the patients were at high risk, 18.2% of them at moderate risk by malnutrition. Statistically significant relationship was also negatively determined between body weight, dry weight, BMI, the waist circumference, and MUST and SGA (p&lt;0.05). A negatively significant relationship was statistically found among albumin, creatinine, hemoglobin and calcium readouts by NRS2002, among albumin, BUN, calcium and phosphorus readouts by MUST, among albumin, hemoglobin and calcium readouts by SGA (p&lt;0.05). Conclusion: It was observed that the dialysis patients could not get the advised nutritional quantities, thence malnutrition progressed. It is concluded that anthropometric measurements are more concordant with MUST and the biochemical symptoms with NRS2002, and therefore both must be taken into consideration in the assessment of nutritional status correctly of the end-stage renal patients undergoing hemodialysis.

Association between inflammatory potential of diet and markers of malnutrition in haemodialysis patients.

In this study, we aimed to examine the relationship between energy-adjusted dietary inflammatory index (E-DII) and a comprehensive profile of malnutrition in Iranian haemodialysis (HD) patients. In this cross-sectional study, 291 participants on HD for at least 6 months before enrollment were included. The current dietary intakes of participants were assessed using a 4-d diet diary-assisted recall, including 2 non-dialysis days and 2 dialysis days to calculate E-DII. To determine the malnutrition status of HD patients, BMI, subjective global assessment (SGA), dialysis malnutrition score (DMS) and malnutrition inflammation score (MIS) were used. Overall, 291 HD patients comprised our study population. After controlling for potential confounders, E-DII was associated with a higher risk of malnutrition, as evidenced by SGA (OR = 2·23; 95 % CI: 1·11, 4·49), DMS (OR = 2·31; 95 % CI: 1·16, 4·60) and MIS (OR = 2·50; 95 % CI: 1·28, 4·88). No significant association was detected between E-DII and BMI either before (OR = 1·78; 95 % CI: 0·83, 3·81) or after adjustment for possible confounders (OR = 1·43; 95 % CI: 0·58, 3·54). This study showed that E-DII was significantly associated with reliable malnutrition markers including SGA, DMS and MIS in HD patients. However, further longitudinal studies are warranted to infer a cause-and-effect relationship between DII and malnutrition.

Screening for malnutrition with malnutrition inflammation score and geriatric nutritional risk index in hemodialysis patients.

Screening malnutrition, which is the most common complication in hemodialysis patients, is extremely important for these patients. Malnutrition inflammation score (MIS) and geriatric nutritional risk index (GNRI) are malnutrition screening tests used in hemodialysis patients in recent years. The purposes of this study are to evaluate the nutritional status of hemodialysis patients with different screening tests and to determine the cutoff values for this disease-specific MIS and GNRI. The study was conducted with 194 adult patients including 98 males and 96 females whose mean age was 53.1 ± 10.96. Subjective global assessment (SGA) and MIS tests were applied, and the GNRI value was calculated for screening malnutrition. MIS and GNRI cutoff values were obtained by adopting the SGA scores as a standard and drawing a receiver operating characteristic curve. The tatistical Package for the Social Sciences-22.0 package program was used in the analysis. According to SGA, 70.7% of the patients were nourished, 21.1% were mildly-moderately malnourished, and 8.2% were found to be severely malnourished. The optimal cutoff value predicted for malnutrition was 6.5 points (94.7% sensitivity and 98.5% specificity) for MIS and 86.0 points (64.9% sensitivity and 62.8% specificity) for GNRI. Based on these cutoff values, 28.9% of the patients were determined to be malnourished according to MIS and 45.4% according to GNRI. In conclusion, screening tests are very important in the early identification of malnutrition in hemodialysis patients. This study was conducted to evaluate the malnutrition of hemodialysis patients with different screening tests. At the end of the study, the availability of MIS was found to be high in detecting malnutrition in hemodialysis patients because of its high accuracy and sensitivity of MIS. The cutoff points we identified for both MIS and GNRI are thought to facilitate the determination of malnutrition.

Protein and Phosphate Intakes are Associated with Hyperphosphatemia in Hemodialysis Patients at Sanglah Hospital, Bali, Indonesia

Increased chronic kidney disease (CKD) mortality rate is significantly associated with increased blood phosphate levels. Hyperphosphatemia control is one of the main focuses in the management of hemodialysis (HD) patients. A high protein diet has been suggested to prevent malnutrition in hemodialysis patients. However, a high protein and phosphorus diet has the risk of increasing the phosphate level in the blood circulation, leading to a higher mortality rate of hemodialysis patients. This study aimed to prove that the level of protein and phosphate intake is associated with hyperphosphatemia in CKD patients with routine HD. This was cross-sectional analytical study conducted from September to October 2020 on 66 CKD patients who underwent hemodialysis. Subject characteristics and phosphorus and protein intake data were obtained from a questionnaire food recall adapted from the Food and Agriculture Organization of the United Nations. Data consumption patterns were processed using the nutritional survey software to obtain the nutritional values. Data were analyzed using the Chi-Square test to identify the relationship and risk between hyperphosphatemia and diet protein, phosphorus, and protein-phosphorus ratio. The confidence level in this study was 95%. There was a significant relationship between protein and phosphorus intake in hyperphosphatemia in CKD patients. The risk factors for hyperphosphatemia were high phosphorus intake (p=0.018; OR=3.886;95% CI: 1.212–12.460) and adequate protein intake (p=0.035; OR=3.674; 95% CI: 1.049-12.865). This study showed no significant relationship between phosphorus-protein ratio, protein-phosphorus ratio, and hyperphosphatemia incidence. In conclusion, high protein intake and excessive phosphorus intake provide a significant relationship to the incidence of hyperphosphatemia in CKD patients undergoing routine hemodialysis.

Differences in Malnutrition Inflammation Score of Hemodialysis Patients Associated With Hemodialysis Factors. A Spanish Multicenter Epidemiologic Study

The aims of this study are to analyze the prevalence of malnutrition in hemodialysis (HD) patients in Spain, and to assess the association of malnutrition in these patients with sociodemographic characteristics, comorbidity, and parameters related to HD. A multicenter, retrospective, cross-sectional study in HD patients from centers all over Spain was conducted. Nutritional status of patients was assessed using Malnutrition Inflammation Score (MIS), and was stratified according to MIS values into 5 categories: ≤2, normal nutrition; >2 to ≤5, mild malnutrition or risk of malnutrition; >5 to ≤7, moderate malnutrition; >7 to ≤10, severe malnutrition, and >10, extreme malnutrition. A total of 52 Spanish HD Units participated in the study enrolling 2,748 patients. Mean age of patients was 68.20±14.24years, 1,811 (65.9%) were men. Mean time on HD was 55.63±63.25months. Using an MIS cut-off point of 2 for malnutrition, 89% of patients were malnourished (MIS > 2). However, with a cut-off point of 5, more commonly described in the literature, the percentage of patients with malnutrition was reduced to 51.7%. Using this cut-off, we observed significant differences between patients with malnutrition and normo-nourished patients in biochemical parameters, age, Charlson Index, HD residual renal function, scheme, and vascular access (permanent catheter vs arteriovenous fistula). A multivariate regression analysis showed that age, sex, HD scheme, vascular access, residual renal function, and comorbidity index were predictive factors for malnutrition. We found that a high percentage of HD patients with malnutrition did not receive oral supplementation. The prevalence of malnutrition in HD patients in Spain, assessed using the MIS scale, was high. Higher malnutrition was associated with the use of catheter versus fistula, and standard HD versus online hemodiafiltration, and with the absence of residual renal function, older age, greater comorbidity, and male sex. Malnourished patients had a low rate of oral supplementation.

Aortic arch calcification affects causes of death in patients on hemodialysis: a retrospective cohort study

BackgroundAortic arch calcification (AAC) is a well-known risk factor for death in patients on hemodialysis (HD); however, the causes of death among them have not been well studied. The study aimed to investigate the distribution of causes of death and long-term prognosis among different degrees of AAC in HD patients.MethodsA retrospective cohort study was conducted on patients undergoing HD at two clinics in Japan. AAC grades 0 to 3 were categorized by chest radiograph at baseline, and mortality and causes of death were collected. A subgroup analysis was performed to evaluate the relationship between causes of death and age, diabetes mellitus, and dialysis vintage in each AAC grade.ResultsA total of 321 patients were included in the analysis. During 5.2 ± 2.1 years, 117 patients died, and the death rates in AAC grades 0, 1, 2, and 3 were 19.3% (17/88), 35.2% (51/145), 46.3% (25/54), and 70.6% (24/34), respectively. The major causes of death were cardiovascular disease (CVD, 39.3%), infection (20.5%), and malignancy (15.4%) in the entire cohort. In AAC grade 3, CVD mortality (33.3%) remains as the most common cause of death, although death of infection (29.2%) and malnutrition (16.7%) increased markedly. A subgroup analysis showed that AAC grade 3 was mostly old, non-diabetic patients with a long dialysis vintage and was susceptible to death of infection or malnutrition.ConclusionsCVD was the most common cause of death among all AAC grades, although death of infection and malnutrition markedly increased in those with severe AAC. Attention should be paid to CVD, infection, and malnutrition in HD patients with severe AAC.