Nutritional Status Of Hemodialysis Patients Research Articles

サルコペニアを有する血液透析患者の栄養指標と食事摂取状況

サルコペニアを有する血液透析患者の栄養指標と食事摂取状況

Assessing the Nutritional Status of Hemodialysis Patients in Sub-Saharan Africa: Experience of Two Hemodialysis Centers in Niger

Introduction: Patients with end-stage chronic renal failure (ESKD) have a significant impairment in their nutritional status. Our study is aiming at evaluating the nutritional status based on clinical and biological parameters. Patient and method: This is a prospective, cross-sectional, descriptive and analytical study carried out in two departments of nephrology/dialysis in Niger from 1 December 2014 to 31 March 2015. The assessment of nutritional status relied on the Body Mass Index (BMI), albuminemia, serum phosphate, hemoglobin, CRP, urea, creatinine levels. Results: Sixty-five patients were involved in the study. The mean age was 44.35 ± 13 years with a sex ratio of 2.09 in favor of men and an average dialysis duration of 43.47 ± 36.55 months. The mean BMI was 21.60 ± 4.47 kg/m2. Undernutrition was noted in 19 patients (29.23%), hypoalbuminemia was found in 13 patients, C-reactive protein (CRP) level was high in 11 patients. In comparative analysis according to the BMI, several parameters were significantly related to undernutrition: hypo-albuminemia, hyperphosphatemia, high CRP, hyperazotemia, anorexia, MUAC, comorbidities, central venous catheter. Conclusion: The prognostic value of undernutrition in chronic hemodialysis patients fosters early recognition and management of all nutritional disturbances in these patients. Assessment and monitoring of nutritional status in chronic hemodialysis require the simultaneous determination of several markers in order to weight the limits of each of the criteria taken in isolation.

FGF23 and Malnutrition in Maintenance Hemodialysis Patients: A Single-Center Study

Background: Malnutrition is a prevalent complication in patients on maintenance hemodialysis and is considered a major risk factor for mortality in those patients. FGF23 has also been associated with mortality in dialysis patients. Little is known about the association between FGF23 and malnutrition in such patients. Aim of the study: The aim of this study was to investigate possible relationship between FGF23 and malnutrition in maintenance hemodialysis patients. 85 patients on maintenance hemodialysis were studied. In addition to routine laboratory parameters, serum intact fibroblast growth factor-23 levels were done, and anthropometric measures were done after reaching dry weight which included MAC, WC and WHR. BMI was calculated for all patients. SGADMS (Subjective Global Assessment -Dialysis Malnutrition Score) was calculated based on medical history and clinical examination. Results: The mean BMI was 20.2 ± 3 kg/m2. The mean hemoglobin level was 9.7 ± 2 g/dl. The mean serum calcium level was 7.6 ± 1 mg/dl. The mean serum albumin was 3.9 ± 1 g/dl. The mean mid-arm circumference was 22.9 ± 2 cm. The mean waist circumference was 90.5 ± 11 cm. The mean malnutrition score was 28.2 ± 3 points. FGF23 levels ranged from 13.5 to 675 ng/L, and accordingly patients were divided into four quartiles. Patients in the lowest FGF23 quartile showed the shortest dialysis vintage, lowest serum calcium, phosphorus, creatinine, albumin, total proteins, MAC, and the highest iPTH level. The highest malnutrition score was associated with the lowest FGF23 quartile. There was highly significant positive correlation between FGF23 level and each of BMI, WHR (p=0.006 and 0.001 respectively) and a highly significant negative correlation with malnutrition score (p=0.000). Conclusion: Low FGF23 levels may be associated with malnutrition in maintenance hemodialysis patients. FGF23 used in conjunction with other objective nutritional assessment tools may be of value in determining nutritional status of hemodialysis patients.

MON-LB017: Assessment of Nutritional Status in Haemodialysis Patients Using PG-SGA and Handgrip Strength

In this cross-sectional study, we primarily aimed to assess prevalence of malnutrition by the Patient Generated Subjective Global Assessment (PGSGA), and muscle strength in haemodialysis patients. Second, we explored to which extent these patients are able to complete the patient component of the PG-SGA, aka PG-SGA Short Form (SF) (weight, intake, symptoms, activities/functioning) independently.

SUN-PP184: The Role of Dialysis Shift in the Nutritional Status of Hemodialysis Patients

SUN-PP184: The Role of Dialysis Shift in the Nutritional Status of Hemodialysis Patients

Study of Serum Levels of Leptin, C-Reactive Protein and Nutritional Status in Hemodialysis Patients.

Background:Leptin is secreted by adipose tissue and decreases appetite. However, the role of leptin in the pathogenesis of hemodialysis (HD)-related malnutrition has not been fully evaluated.Objectives:The aim of study was to investigate the association between the serum leptin levels, serum C-reactive protein (CRP) levels, and nutritional status in hemodialysis patients.Patients and Methods:This analytical descriptive study included 45 hemodialysis patients and 40 healthy subjects. Biochemical parameters and serum leptin levels were measured. The nutritional status was evaluated using a food frequency questionnaire (FFQ) and the calculation of the body mass index (BMI).Results:Serum leptin (P < 0.05) and albumin (P < 0.0001) levels and BMI (P < 0.001) of HD patients were significantly lower, while CRP levels were significantly higher than those of controls (P < 0.0001). HD patients consumed the lower daily servings of the food groups compared to the control subjects (P < 0.0001). A significant positive correlation between serum levels of leptin and albumin and BMI was demonstrated. No significant correlations were identified between leptin level, CRP level, and other variables.Conclusions:The findings suggest that low levels of leptin may be a contributory factor for malnutrition in HD patients. Further studies are required to ascertain the significance of leptin levels in relation to nutritional factors in hemodialysis patients.

Evaluation of Nutritional Biochemical Parameters in Haemodialysis Patients over a Ten-year Period.

Protein-energy malnutrition as well as systemic inflammation and metabolic disorders are common in patients with chronic kidney failure, who require renal replacement therapy (haemodialysis). Such malnutrition is a factor that significantly contributes to their morbidity and mortality. This study evaluated the nutritional status of haemodialysis patients by assessing biochemical and anthropometric parameters in order to determine whether these patients suffered disorders reflecting nutritional deterioration directly related to time on haemodialysis. This research comprised 90 patients of both genders with chronic kidney failure, who regularly received haemodialysis at our unit over a period of ten years. The patients' blood was tested quarterly for plasma albumin, total cholesterol and total proteins, and tested monthly for transferrin. The patients' weight, height and body mass index (BMI) were monitored. Body mass index was calculated using the formula: weight (kg)/height (m2 ) and classified in one of the following categories defined in the World Health Organization (WHO) Global Database on Body Mass Index: (i) underweight [BMI < 18.50], (ii) normal [BMI 18.50 - 24.99], (iii) overweight [BMI 25 - 29.99], (iv) obese [BMI > 30]. In the ten-year period of the study, the patients experienced a substantial decline in their biochemical parameters. Nevertheless, their BMI did not show any significant changes despite the patients' state of malnutrition. The prevalence of malnutrition in haemodialysis patients was evident. Nevertheless, the BMI of the subjects did not correspond to the biochemical parameters measured. Consequently, the results showed that the nutritional deterioration of these patients was mainly reflected in their biochemical parameters rather than in their anthropometric measurements.

Effects of resistance exercise training on acyl-ghrelin and obestatin levels in hemodialysis patients

Background: Patients undergoing hemodialysis (HD) present altered levels of appetite hormones such as acyl-ghrelin (orexigenic) and obestatin (anorexigenic), which may contribute to anorexia. Physical exercise may affect these hormones and improve appetite in these patients. Objectives: The objective of this study is to evaluate the effects of a resistance exercise program in appetite hormones, body composition, and nutritional status in HD patients. Design: Intervention study with the control group. Subjects: Fifty-two patients on regular HD program were enrolled into two groups: 37 patients performed exercises (56.7% male, 45 ± 12.8 years, 57 (9–192) months on HD) and 15 patients comprised the control group (66.7% men, 50 ± 10.6 years, 57 (11–153) months on HD). Measurements: Exercise program (performed with elastic bands and ankle cuffs in both lower limbs) was supervised three times a week during 6 months (72 sessions). Patients had their blood drawn in a regular HD day after overnight fasting, before and after 6 months of exercise program. Obestatin, acyl-ghrelin, routine biochemical parameters, quality of life, and anthropometric data were collected and analyzed before and after 6 months. Results: After 6 months of exercise, obestatin levels reduced [from 3.0 ng/mL (2.3–3.4) to 1.9 ng/mL (0.6–3.4)] and acyl-ghrelin levels increased [from 21.5 pg/mL (1.3–77.7) to 37.2 pg/mL (16.7–94.1)] and the control group presented no significant differences in both plasma levels of hormones. Body composition and physical functional assessed by SF-36 and albumin levels (3.7 ± 0.3 to 3.9 ± 0.2, p < 0.05) improved after exercises. Conclusion: Six months of resistance exercises contributed to changes in plasma appetite hormones, body composition, and nutritional status in hemodialysis patients.

Correlation between anthropometry, biochemical markers and subjective global assessment-dialysis malnutrition score as predictors of nutritional status of the maintenance hemodialysis patients

Background: Protein energy malnutrition is the major cause of poor prognostic outcome in patients on maintenance hemodialysis (MHD). The assessment of nutritional status in patients on maintenance hemodialysis should be done both subjectively and objectively by integrating clinical, biochemical and anthropometric measurements. A study was conducted to assess the possible correlations between the subjective global assessment-dialysis malnutrition score (SGA-DMS), anthropometric measurements, and biochemical parameters in hemodialysis patients. Methods: The study included 90 patients (55 males and 35 females; age range of 25 to 73 years; mean age 52.62 ± 11.7 years) undergoing twice/thrice weekly maintenance hemodialysis for six months and above in the dialysis unit of a tertiary care teaching hospital. The MHD patients were assessed by SGA -DMS, anthropometry and biochemical indicators (serum albumin, iron, ferritin and transferrin) of nutritional status. Results: According to the SGA-DMS 54.4 % were moderate to severely malnourished, 31% were mild to moderately nourished and 14.4% were well nourished. There was a highly significant negative correlation between SGA –DMS and serum albumin, iron, transferrin; positive correlation between SGA-DMS and ferritin (P<0.0001). Body mass index, upper arm circumferences, and skin fold thickness had a highly significant negative correlation with SGA-DMS (P<0.001), where as the lean body mass, total body water and the fat free mass had a significant negative correlation (P<0.05). Conclusion: SGA-DMS correlated with anthropometric and biochemical parameters that are indicative of nutritional status. SGA –DMS used in conjunction with other objective nutritional assessment methods may be of greater impact in determining nutritional status of hemodialysis patients.

Elevated Serum Leptin Level Is Associated with Body Mass Index But Not with Serum C-reactive Protein and Erythrocyte Sedimentation Rate Values in Hemodialysis Patients.

Objectives:Aim of the present study was to investigate serum concentration of leptin and its association with values of body mass index (BMI), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in hemodialysis (HD) patients.Methods:This cross-sectional study included 60 HD patients (34 male, 26 female) and 30 age- and sex-matched (4 males, 26 females) apparently healthy subjects. Serum leptin concentration was determined by an enzyme-linked immunosorbent assay (ELISA). Serum CRP concentration was measured by means of particle-enhanced immunonephelometry. ESR value was determined by Western Green method. BMI was calculated as weight (kg) divided by height squared (m2).Results:Results have shown that median serum leptin concentration (30.65 ng/mL; 12.48-86.40 ng/mL) was statistically significantly higher in HD patients compared to median serum leptin concentration (15.75 ng/mL; 9.15-30.65 ng/mL) in the control group of healthy subjects (p<0.05). Likewise, median serum CRP concentration (5.5 mg/L; 1.93-8.9 mg/L) and median ESR value (57.5 mm/h; 40.5-77.0 mm/h) were significantly higher in HD patients compared to median serum CRP concentration (0.8 mg/L; 0.38-1.43 mg/L) (p<0.001) and median ESR value (10.0 mm/h; 6.5-14.0 mm/h) (p<0.001) determined in the control group. Statistically significant positive correlation was found between BMI values and serum leptin concentration in HD patients (rho=0.434; p<0.001). Positive, although not significant, correlation was observed between serum CRP and leptin levels in HD patients (rho=0.171; p>0.05). Negative correlation between ESR values and serum leptin concentrations in HD patients was determined but it was not statistically significant (rho= -0.029; p>0.05).Conclusions:Increased serum concentration of leptin as pro-inflammatory cytokine as well as elevated serum values of CRP and ESR indicate presence of systemic micro inflammation in HD patients. Results of the present study point to possible use of serum leptin concentration as an indicator of nutritional status in HD patients based on observed significant positive correlation between serum leptin concentrations and BMI values. However, absence of significant association between serum leptin and CRP levels as well as between serum leptin concentrations and ESR values in HD patients requires further investigation and clarification.

栄養障害を呈する血液透析患者の身体機能および栄養指標に対する血液透析中のレジスタンストレーニングの効果

栄養障害を呈する血液透析患者の身体機能および栄養指標に対する血液透析中のレジスタンストレーニングの効果

Nutritional assessment and its correlation with anthropometric measurements in hemodialysis patients.

One of the most important problems in patients on hemodialysis (HD) is chronic malnutrition. This study is aimed to assess the prevalence of malnutrition using a subjective global assessment (SGA) in HD patients referred to the Valie ASR Hospital, Arak, Iran. In this descriptive analysis study, 190 HD patients were selected with random sampling. SGA and anthropometric and biochemical measurements were assessed in all patients. Data were analyzed with the Chi-square and t-tests and Pearson correlation coefficient. P <0.05 was considered statistically significant. Of the 190 patients studied, 78 patients (41.1%) were male and 112 patients (58.9%) were female. Sixteen patients were detected to have adequate nutritional status (8.4%), 90 (47.4%) had mild malnutrition and 84 patients (44.2%) had moderate malnutrition. We found a significant negative correlation of SGA score with patient's weight (r = -0.147) and patient's body mass index (BMI) (r = -0.238). Also, it correlated significantly with duration of dialysis treatment (years) (r = 0.404). The SGA score showed a significant negative correlation with mid-arm circumference (MAC) (r = - 0.152). No significant correlation was found between SGA score and mid-arm muscle area. Our study showed that >50% of patients on maintenance HD had mild or moderate malnutrition. There was no case of severe malnutrition. Duration of dialysis treatment and some anthropometric indices (weight, BMI and MAC) also showed a significant correlation with SGA score, which are important to determine the nutritional status of HD patients.

Reliability of Bioelectrical Impedance Analysis in the Evaluation of the Nutritional Status of Hemodialysis Patients — A Comparison With Mini Nutritional Assessment

IntroductionProtein-energy wasting (PEW) is a strong predictive factor for morbidity and mortality in patients who have end-stage renal disease (ESRD). Mini Nutritional Assessment (MNA) is an important and confirmed tool to evaluate PEW that has been recommended by many guidelines. Bioelectrical impedance analysis (BIA) is a noninvasive technique for assessing body composition. The aim of the present study was to analyze the reliability of BIA in malnutrition diagnosis by comparing it with standard MNA in a group of 100 ESRD patients. MethodsOne hundred ESRD patients who were medically stable and under dialysis treatment for at least 6 months were enrolled to the study. Monthly assessed serum creatinine, albumin, C-reactive protein (CRP), and lipid profiles from the last 6 months prior to the study were retrospectively collected. A standard Full-MNA and body composition analyses were applied to all patients. Body compositions were analyzed with the BIA technique using the Body Composition Analyzer (Tanita BC-420MA; Tanita, Tokyo, Japan). Patients were classified into three groups according to MNA scores as PEW (n = 15, score <17), moderate PEW or risk group (n = 49, score 17–23.5), and well-nourished (n = 36, score ≥24) patients. ResultsMean duration of maintenance hemodialysis treatment was significantly shorter in the PEW group compared to both of the other groups described (P = .015). Well-nourished and risk groups had lower CRP and higher albumin levels compared to PEW patients; however, these values were statistically similar in these two groups (P = .018, .01, respectively). According to BIA findings, well-nourished patients had the highest fat ratio, fat mass, muscle mass, visceral fat mass, and fat-free mass compared to both moderate the PEW/risk and the PEW groups (P < .05). Risk group patients also had higher muscle mass, visceral fat mass, and fat-free mass values compared to the PEW group (P < .05). A correlation analysis revealed that MNA scores were positively correlated with albumin (P = .005), creatinine (P = .049), fat mass (P = .045), muscle mass (P = .001), visceral fat ratio (P = .007), and BMI (P = .047) and in negative correlation with CRP (r = −0.357, P = .0001) levels. ConclusionsWe recommend BIA as a complementary diagnostic tool to evaluate nutritional status of ESRD along with MNA, anthropometric measures, and classical biochemical markers.

영양교육과 규칙적인 운동이 혈액투석환자의 영양상태와 삶의 질 및 피로도에 미치는 효과

ABSTRACT The purpose of this study was to investigate the effects of a nutrition education and exercise on nutritional status in hemodialysis patients, with regard to quality of life (QoL), and fatigue. The subjects were divided into two groups : an educated (E) group (11 men and 9 women) and a non-educated (NE) group (7 men and 22 women). The educated group received a nutrition education and a regular exercise program for 3 months. Data on anthropometric indices and biochemical parameters were obtained from medical records. Dietary hab-its and nutrient intake were assessed through questionnaires and three-day food records. QoL (through the SF-36 questionnaire) and fatigue (measured by a visual analogue scale questionnaire) were assessed before and after the interventions. Dietary habit scores regarding food variety and fluid intake control significantly in-creased (P＜0.05) after the nutrition education. Furthermore, the intake of total energy, carbohydrates, Fe, and vitamin A significantly increased (P＜0.05). Vitamin C intake also significantly increased (P＜0.01). Hb levels decreased whereas TG levels increased in the NE group. BUN levels decreased in the E group. After the nu-trition education, QoL aspects, such as feelings of pain and general health, and the total score significantly increased (P＜0.05) and the level of fatigue score decreased (P＜0.01). The results of this study indicate that nutrition education and exercise for hemodialysis patients provides changes in dietary habit, daily nutrient in-take, biochemical parameters, QoL, and the level of fatigue. Therefore, nutrition education and exercise help improve nutritional status and QoL.

Comparison Analysis of Nutritional Scores for Serial Monitoring of Nutritional Status in Hemodialysis Patients

This study aimed to compare the longitudinal performance of the malnutrition-inflammation score (MIS) and the geriatric nutritional risk index (GNRI), two nutritional scores for patients on maintenance hemodialysis. Nutritional scores, dietary intake, biochemical markers, and body composition analysis were performed at baseline and at 6, 12, and 18 months after enrollment (which took place from January through December 2006) on 75 prevalent hemodialysis patients (43% women, mean age 64.8 ± 11.9 years). The patients underwent simultaneous MIS and GNRI assessments calculated by two independent examiners from baseline. The study period was 46.8 ± 16.4 months. GNRI had higher interobserver agreement (weighted κ-score 0.98) than MIS (weighted κ-score 0.62). Longitudinally, a 1-unit increase in MIS was associated with a 0.41 kcal/kg per day reduction in daily energy intake (P<0.001) and with a 0.014 g/kg per day reduction in nPNA (P=0.02). GNRI did not correlate with the change over time of dietary intake. Longitudinal changes of both scores were associated with appropriate changes over time in levels of nutritional biomarkers, inflammation (IL-6), and body composition parameters. Both scores expressed significant associations with prospective hospitalization, whereas only MIS was associated with mortality in this cohort. The multivariate Cox proportional hazard ratio was 1.15 for death for each 1-unit increase in the MIS (95% confidence interval, 1.03-1.3; P=0.02). Both MIS and GNRI are valid tools for longitudinal assessment of hemodialysis patients' nutritional status. MIS has lower interobserver reproducibility than GNRI; however, MIS is more comprehensive than GNRI.

Assessment of nutritional status in haemodialysis patients.

Malnutrition is a common problem and a risk factor of mortality in haemodialysis patients. However, there is no consensus for its assessment. To assess the relationship between nutritional status, measured by bioimpedance spectrometry (BIS), and laboratory markers of nutritional status, as well as nutritional evolution and its changes after 1 year. We performed an observational prospective study on 124 haemodialysis patients (aged 61.2 ±[15.8] years, 62.9% were males, 33.1% were diabetic. Laboratory markers of nutritional status and BIS were implemented at baseline and after one year. At baseline, lean mass index (LMI) (13.3 [3.6] Kg/m2) was inversely correlated with age (P=.006), and directly with male gender (P=.01). At baseline, the fat mass index (FMI) (mean 11.2 & 6.1kg/m2) correlates directly with the body mass index (P<.001) and the female gender (P=.004). We found no association with comorbidity or inflammatory markers. We did not observe any correlation between lean mass or fat mass modifications and nutritional marker modifications. Patients with LMI gain (>0kg/m2) have lower baseline serum albumin (P=.017), lower baseline LMI (P<.001) and higher baseline FMI (P=.027). Patients with FMI loss (<0kg/m2) have lower systolic blood pressure (P=.04). Assessment of nutritional status through laboratory parameters does not have a good correlation with body composition parameters or with their modifications.

Nutritional Status and Body Composition in Early Post-Renal Transplantation: Is There an Adiponectin Paradox?

Overweight, in combination with other cardiovascular risk factors, reduces survival after renal transplantation. The aim of this cross sectional study was to observe adiponectin as a predictor of body mass index (BMI) and anthropometric measurements and also as a risk factor associated with nutritional status after renal transplantation. Ninety subjects were enrolled into this study, 30 patients with end stage kidney disease on regular hemodialysis treatment, 30 patients examined one months after transplantation while 30 subjects used as control group. All diabetic patients were excluded. Full history taking was focused on social status, occupation, original renal disease, duration of transplantation, and co-morbid conditions. Physical examination included hydration status, signs of sepsis and anthropometric measurements. Assay of serum creatinine, blood urea, lipid profile, serum albumin, fasting blood sugar, was done. Quantification of serum adiponectin concentration was estimated by ELISA. We found a significant difference between nutritional status of hemodialysis patients and those after transplantation. The adiponectin level was higher in patients on regular hemodialysis than in kidney transplant group. Before transplantation, adiponectin was negatively related to albumin and body mass index. After transplantation, adiponectin level dropped significantly compared to pretransplant levels, however, it is still negatively related to body mass index. Adiponectin levels did not drop to control levels after transplantation although patients had normal renal function. There was no relationship between adiponectin levels and other nutritional parameters in this study. We can conclude that a disturbed energy metabolism persists after renal transplantation, where adiponectin is involved.

Selenium supplementation improves the nutritional status of hemodialysis patients: a randomized, double-blind, placebo-controlled trial

Malnutrition is highly prevalent in hemodialysis (HD) patients. These patients have high levels of oxidative stress and inflammation which can subsequently induce malnutrition. Selenium levels have been found to be decreased in HD patients. As selenium deficiency leads to oxidative stress and inflammatory response, the aim of this study was to evaluate the effects of selenium supplementation on oxidative and inflammatory markers and the nutritional status of HD patients. In this randomized double-blind placebo-controlled trial, 80 patients on stable HD for at least 3 months without any acute illness or active infections were randomly allocated to two equal groups to receive one selenium (200 µg) or placebo capsule daily for 12 weeks. Serum levels of lipoproteins, malondialdehyde (MDA), interleukin-6 (IL-6), high-sensitivity C-reactive protein (HSCRP), homocysteine, ferritin and transferrin as well as the subjective global assessment (SGA) score, malnutrition-inflammation score (MIS) and hemoglobin (Hb) levels were measured at the baseline and at the end of the treatment phase. The primary outcome was a change in the nutritional status measured by the SGA score from the baseline towards the end of the treatment phase of the study. The SGA score and MIS decreased significantly in the selenium group compared to the placebo group (P < 0.001 for both). Moreover, serum levels of MDA decreased significantly in the selenium group compared with increasing levels in the placebo group (P < 0.001). Selenium supplementation also hindered an increase in IL-6 levels compared with the placebo group (P = 0.016). There were no significant differences between the selenium and placebo groups in terms of changes in serum levels of lipoproteins, HSCRP, homocysteine, ferritin and transferrin or Hb levels. This study shows that selenium may be an effective complementary supplement for reducing the severity of malnutrition in HD patients through alleviating oxidative stress and inflammation.

Effects of 12 weeks nutrition education on nutritional status in hemodialysis patients

Protein-energy malnutrition is present in a large proportion of patients with end stage renal disease and, is a strong risk factor for mortality in these patients. This study was aimed to evaluate the effectiveness of 12-weeks nutrition education during the hemodialysis session for the improvement of nutritional status. From the June 2011 to the September 2011, patients who were on regular hemodialysis in Pusan National University Hospital were enrolled in this study. In education group, intensive nutrition education was performed by the hemodialysis nurse, for fifty to sixty minutes during the hemodialysis session, once a week. Curriculum for renal nutrition includes regular taking of their medication, intake of moderate amount of protein and sufficient calories, reduction of water, salt, potassium and phosphate intake. Otherwise, any education program was not performed in patients of control group. Nutrition status was assessed by the subjective global assessment (SGA),body mass index (BMI), triceps skinfold thickness (TSF), arm muscle area(AMC) and laboratory markers such as serum albumin, serum blood urea nitrogen(BUN) and hemoglobin(Hb) level before and after the education. Effect of nutrition education was analyzed using ANCOVA test. A total of 49 patients were enrolled in this study and nutrition education was provided to 25 hemodialysis patients. Their mean age was 57.20±15.49 in education group and 55.13±14.42 in control groupand male was 56.0% in education group and 50.0% in control group and, other baseline characteristics were not significantly different between two groups. After the 12-week education, significant improvement was found in SGA, serum albumin, BUN and Hb level. SGA score was improved from 6.36±0.99 to 6.72±0.61 in education group, compared to control group(6.38±0.88 to 6.42±0.88, p=0.029 ). Improvement of serum albumin level, BUN and Hb was as follows: serum albumin(4.23±0.28 to 4.30±0.25 in education group, 4.28±0.39 to 4.13±0.34 in control group, p=0.040), serum Hb(10.45±1.49 to 11.13±1.74 in education group, 10.51±1.12 to 10.04±1.02 in control group, P=0.004), serum BUN(66.52±18.76 to 70.94±17.26 in education group, 59.50±13.61 to 58.68±13.88 in control group, p=0.032). 12 week nutrition education during the hemodialysis session by hemodialysis nurse was effective

Empowering Esrd Patients For Assisted Self Nutritional Care: A Simple But Effective Intervention For Improving Nutritional Status Of Hemodialysis Patients

Protein energy wasting (PEW) is a prevalent problem among hemodialysis patients. Lack of adherence to dietary principle based conventional diet charts often fail to satisfy the nutritional requirements of the patients. We studied the effect of simple nutritional training and empowerment of the patients to formulate their own dietary menu in nutritional parameters of hemodialysis patients in 68 stable non diabetic End stage renal disease (ESRD) patients who are on maintenance hemodialysis. The factors which otherwise can affect the nutritional status like sepsis, malignancy,tuberculosis were excluded. At the beginning patient's baseline nutritional status was assessed by anthropometric measurements, Subjective Global Assessment and serum albumin level. Body composition was assessed by linear regression equation (Durin-Womersley) and Siri equation. The patients were divided in two comparable groups (Group-A&B). In group A patients were prescribed individualized dietary prescription; based on their nutritional allowance as per KDOQI guideline. In Group-B the patients were initially made familiar with the dietary principals of the commonly consumed food. Then they were trained by renal nutritionist by study material, visual aid, and proportional food models and one to one discussion to formulate a dietary menu, by these they were empowered to formulate their own dietary menu. They were constantly assisted when faced any problem. In both the group the nutritional parameters were reassessed after three months of intervention. The results were analyzed statistically. There was statistically significant mean increment in the fat free mass index in GroupB[0.8%(Gr.-A)Vs1.0%(Gr.-B),( p <0.05)], the mean increment in the serum albumin in the GroupB was also significantly higher than GroupA[(0.6gm/dl(Gr.A) Vs 0.9 gm/dl(Gr.B), p <0.0]).Compared to Group-A there was statistically favorable anthropometric changes in Group-B. In conclusion patient empowerment and self nutrition care is proved to be an effective intervention for improving nutritional status in hemodialysis patients.