FACTORS INFLUENCING NUTRITIONAL STATUS IN PATIENTS ON LONG TERM HEMODIALYSIS

Introduction:

Protein energy malnutrition (PEM) is seen in 20-60% of the dialysis population, it is associated with low quality of life (QOL) and higher risk of morbidity and mortality. We assessed nutritional status of dialysis patients, the factors influencing it and outcomes of patients over time with respect to their nutritional status.

Methods:

We included 71 patients >18 years; stable on maintenance hemodialysis for at least 6 months. Patients with decompensated liver disease, catabolic states like tuberculosis and malignancy were excluded. They were evaluated with detailed history, physical examination and laboratory parameters analysing nutritional status. Subjective global assessment(SGA) score and socio-economic status (SES) were recorded. These were repeated for all patients, every 3 months, for a total of 18 months. Nutritional status was classified as adequate nutrition (SGA-A), mild to moderate malnutrition  (SGA-B), and severe malnutrition(SGA-C). SES was determined using modified Kuppuswamy classification. Nutrition supplements and dietary counselling were done according to standard protocol of the hospital. This being an observational study, no interventions were done.

Statistical analysis was performed by using IBM-SPSS Statistics version-23 software. Categorical variables were expressed as percentages and continuous variables as mean ± standard deviation. Statistical significance of mean differences was compared using t-test across cohorts. All values were considered significant if p-value was < 0.05. 

Results:

 Mean age was 59.7 ± 11.8 years (n=71), dialysis vintage was 34.74 months. Patients from higher SES had better physical and laboratory parameters related to nutrition. Nutritional parameters were statistically similar among patients with different SGA scores. There was no difference among vegetarians or non-vegetarians. All people with malnutrition in our cohort belonged to SGA-B and 84% of these belonged to SES class 2 and 3. During follow-up, nutrition improved in 50% of patients who were SGA-B to SGA-A, however, 22.2% of patients who were initially in SGA-A category had changed to SGA-B. Dietary choice (vegetarian v/s mixed) or nutritional supplements did not impact the nutritional status during study period. There were 136 admissions among the study subjects, with a mean of 1.91 admissions per patient in 18 months. 10  patients died during the study period. A gradual reduction in serum albumin was predictive of mortality.

Conclusions:

Malnutrition was seen in 32% of patients. Among all study subjects, nutritional status marginally deteriorated despite standard care with long term hemodialysis. Patients aged >65 years were found to have  gradual reduction in weight, BMI, haemoglobin and albumin levels. There was no single parameter which predicted malnutrition on follow up of 18 months in our dialysis population

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.