Assessment of Nutritional Status in Chronic Hemodialysis Patients at the Galayanivadhana Hemodialysis Unit

Abstract

Malnutrition in patients on maintenance hemodialysis (HD) is an important problem commonly associated with increased risk of morbidity and mortality. The aims of this study are to assess the nutritional status and to determine the cause (s) of malnutrition in stable chronic HD patients treated at the Galayanivadhana Hemodialysis Unit, Siriraj Hospital.
   A total of 145 patients were included in the study and their nutritional status was determined by a questionnaire, a 3-day dietary record, and biochemical and anthropometric assessments including body mass index, ideal and relative body weight, subcutaneous skin fold, % body fat and mid-arm ircumference.
   The prevalence of malnutrition in the studied patients is 52.4%: 27.6% with mild, 16.6% with moderate and 8.3% with severe degrees. Most patients received fewer than 35 Kcal/kg/day. The prevalence of malnutrition is comparable to that reported by Siriraj’s Dialysis Unit (42%) but is less than that of Rajavithee Hospital (81.5%). According to statistical analyses, the factors associated with malnutrition are age, economic factors, patient rights, occupation, plasma cholesterol, Kt/V [two times per week], Hct, Epo treatment and nutritional score. In contrast, there is no association with the presence of a caretaker, educational level, sight viewing, serum C-reactive protein, frequency and sufficiency of HD, number of reused dialyzer, nPCR, Kt/V [three times per week], ideal body weight and height.
   Our study indicates that assessment of nutritional status in HD patients is crucial in particular for those with economic problems, insufficient dietary nutrient intake, low Hct value, and low plasma cholesterol. This is an important and challenging task for HD nurses who are close to patients and their relatives as well as nutritionists who give dietary advice in order to improve the quality of life in chronic HD patients.