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Assessment of nutritional status in patients undergoing maintenance hemodialysis: a single-center study from Iran.
Saudi J Kidney Dis Transpl. 2007 Sep; 18(3):397-404.SJ

Abstract

Malnutrition is a relatively common problem in patients on hemodialysis (HD) and is associated with increased morbidity and mortality in affected patients. With the aid of subjective global assessment (SGA), a semi-quantitative scale for estimating nutritional status, the malnutrition score (MS), has been developed. The MS incorporates advantages of the SGA while extending the reliability and precision. This study was performed to assess the nutritional status in patients on HD at the Mostafa Khomeini Hospital, Tehran, Iran. Based on the MS, which consists of seven components--weight change, dietary intake, gastrointestinal (GI) symptoms, functional capacity, comorbidity, subcutaneous fat, and muscle wasting--we conducted a cross-sectional descriptive-analytic study on 54 HD patients (35 males, 19 females) with age range of 18 to 82 years (mean 44.2 +/- 19.8 years). Each component of the MS has a score from one (normal) to five (very severe). Anthropometric measurements including triceps skin-fold thickness (TSF), mid-arm circumference (MAC) and mid-arm muscle circumference (MAMC) were taken on all patients. Also, the body mass index and TSF/MAC ratio were calculated. Relevant laboratory parameters were checked. The duration of HD of the study patients ranged between 5 and 36 months (mean 19.5 +/- 1.5 months). Data analysis was carried out using the SPSS, Pearson correlation, 't' test and regression. Based on the MS, 40.7% of patients had malnutrition (mean score 13.8 +/- 2.8). There were statistically significant correlations between TSF (p < 0.01), MAC (p = 0.02), MAMC (p = 0.01), TSF/MAC ratio (p < 0.001), BMI (p = 0.028), serum albumin concentration (p = 0.021) and MS. No statistically significant correlation was found between the MS and urea reduction ratio, protein catabolic rate, age, gender, or duration of dialysis. After 1 year, 20.4% of patients died because of dialysis-related complications. The mortality rate did not show significant correlation with age, presence of diabetes mellitus, biochemical parameters, and anthropometric measures. A significant correlation was found between the protein catabolic rate (nPCR) and the mortality rate (regression analysis, p = 0.016); lower values of nPCR were associated with increased mortality. Our study suggests that the MS is a reliable, precise, and rapid method for estimating the nutritional status in patients on HD. The nPCR can be used as a predictor of increased mortality. Further studies with larger sample size and longer duration are required to confirm this observation.

Authors+Show Affiliations

Shahed University, Mostafa Khomeini Hospital, Tehran, Iran. R2AFSHAR@yahoo.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17679753

Citation

Afshar, Reza, et al. "Assessment of Nutritional Status in Patients Undergoing Maintenance Hemodialysis: a Single-center Study From Iran." Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, vol. 18, no. 3, 2007, pp. 397-404.
Afshar R, Sanavi S, Izadi-Khah A. Assessment of nutritional status in patients undergoing maintenance hemodialysis: a single-center study from Iran. Saudi J Kidney Dis Transpl. 2007;18(3):397-404.
Afshar, R., Sanavi, S., & Izadi-Khah, A. (2007). Assessment of nutritional status in patients undergoing maintenance hemodialysis: a single-center study from Iran. Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 18(3), 397-404.
Afshar R, Sanavi S, Izadi-Khah A. Assessment of Nutritional Status in Patients Undergoing Maintenance Hemodialysis: a Single-center Study From Iran. Saudi J Kidney Dis Transpl. 2007;18(3):397-404. PubMed PMID: 17679753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of nutritional status in patients undergoing maintenance hemodialysis: a single-center study from Iran. AU - Afshar,Reza, AU - Sanavi,Suzan, AU - Izadi-Khah,Akram, PY - 2007/8/8/pubmed PY - 2008/1/18/medline PY - 2007/8/8/entrez SP - 397 EP - 404 JF - Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia JO - Saudi J Kidney Dis Transpl VL - 18 IS - 3 N2 - Malnutrition is a relatively common problem in patients on hemodialysis (HD) and is associated with increased morbidity and mortality in affected patients. With the aid of subjective global assessment (SGA), a semi-quantitative scale for estimating nutritional status, the malnutrition score (MS), has been developed. The MS incorporates advantages of the SGA while extending the reliability and precision. This study was performed to assess the nutritional status in patients on HD at the Mostafa Khomeini Hospital, Tehran, Iran. Based on the MS, which consists of seven components--weight change, dietary intake, gastrointestinal (GI) symptoms, functional capacity, comorbidity, subcutaneous fat, and muscle wasting--we conducted a cross-sectional descriptive-analytic study on 54 HD patients (35 males, 19 females) with age range of 18 to 82 years (mean 44.2 +/- 19.8 years). Each component of the MS has a score from one (normal) to five (very severe). Anthropometric measurements including triceps skin-fold thickness (TSF), mid-arm circumference (MAC) and mid-arm muscle circumference (MAMC) were taken on all patients. Also, the body mass index and TSF/MAC ratio were calculated. Relevant laboratory parameters were checked. The duration of HD of the study patients ranged between 5 and 36 months (mean 19.5 +/- 1.5 months). Data analysis was carried out using the SPSS, Pearson correlation, 't' test and regression. Based on the MS, 40.7% of patients had malnutrition (mean score 13.8 +/- 2.8). There were statistically significant correlations between TSF (p < 0.01), MAC (p = 0.02), MAMC (p = 0.01), TSF/MAC ratio (p < 0.001), BMI (p = 0.028), serum albumin concentration (p = 0.021) and MS. No statistically significant correlation was found between the MS and urea reduction ratio, protein catabolic rate, age, gender, or duration of dialysis. After 1 year, 20.4% of patients died because of dialysis-related complications. The mortality rate did not show significant correlation with age, presence of diabetes mellitus, biochemical parameters, and anthropometric measures. A significant correlation was found between the protein catabolic rate (nPCR) and the mortality rate (regression analysis, p = 0.016); lower values of nPCR were associated with increased mortality. Our study suggests that the MS is a reliable, precise, and rapid method for estimating the nutritional status in patients on HD. The nPCR can be used as a predictor of increased mortality. Further studies with larger sample size and longer duration are required to confirm this observation. SN - 1319-2442 UR - https://www.unboundmedicine.com/medline/citation/17679753/Assessment_of_nutritional_status_in_patients_undergoing_maintenance_hemodialysis:_a_single_center_study_from_Iran_ L2 - http://www.sjkdt.org/article.asp?issn=1319-2442;year=2007;volume=18;issue=3;spage=397;epage=404;aulast=Afshar DB - PRIME DP - Unbound Medicine ER -