ABSTRACT
The risk of cardiovascular diseases among hemodialysis patients with energy-protein malnutrition [PEM] is higher compared to well-nourished hemodialysis patients. Traditional risk factors for cardiovascular diseases such as a high body mass index and serum total cholesterol cannot explain the high prevalence of cardiovascular diseases in hemodialysis patients with PEM. Therefore, the present study was designed to study the association of PEM with nontraditional risk factors of cardiovascular diseases in hemodialysis patients. A total of 291 hemodialysis patients were selected with systematic randoml sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was determined by subjective global assessment [SGA]. In addition, dialysis malnutrition score [DMS] and malnutrition inflammation score [MIS] of the patients were determined and their dietary intakes assessed using a 4-day dietary recall including 2 dialysis days and 2 non-dialysis days. Also, after a 12- to 14-hour fast, an 8 mL- sample of blood was taken from each patient before dialysis and serum urea, creatinine, albumin, CRP, sICAM-1, sVCAM-1, sE-selectin, MDA, NO, endothelin-1, and Lp[a] were measured. The serum concentrations of CRP and sICAM-1 were significantly higher in hemodialysis patients with PEM as compared to those without PEM [p<0.01], whereas there were no significant differences in serum concentrations of sVCAM-1, sE-selectin, MDA, NO, endothelin-1 or Lp[a] between the two groups. In addition, compared to hemodialysis patients with PEM types IIa or IIb, those with PEM type I had significantly lower serum CRP and sICAM-1 levels [p <0.01]. There were significant direct correlations between DMS and MIS, as two PEM indicators, with serum CRP and sICAM-1 [P <0.01]. The results of the present study indicate that nontraditional risk factors of cardiovascular diseases do not increase in hemodialysis patients with PEM type I, whereas serum CRP and sICAM-1, two risk factors of cardiovascular diseases, increase in PEM type II, which is accompanied with inflammation
ABSTRACT
Protein-energy malnutrition [PEM] is prevalent among hemodialysis patients. So far, no study has compared various methods for determination of PEM, including subjective global assessment [SGA], dialysis malnutrition score [DMS], malnutrition inflammation score [MIS], and body mass index [BMI], in hemodialysis patients. The present study was designed to determine sensitivity, specificity, accuracy, positive and negative predictive values, as well as positive and negative likelihood ratios of DMS, MIS and BMI in comparison with SGA as the most common method for determination of PEM in hemodialysis patients. A total of 291 hemodialysis patients were randomly selected by systematic sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was assessed by completing SGA, DMS and MIS forms and determining BMI. In addition, after a 12- to 14-hour fast, 4-mL blood samples were obtained from each patient before dialysis for measurement of serum urea, creatinine, albumin and total iron binding capacity. Based on SGA, DMS, MIS, and BMI, the prevalence of mild-to-moderate PEM in Tehrani hemodialysis patients was, respectively, 60.5%, 61.5%, 54%, and 16.5%, and that of severe PEM 1%, 1.5%, 1%, and 1%. In comparison with SGA, the sensitivity, specificity, accuracy, area under the receiver operating characteristic [ROC] curve, positive and negative predictive values, and positive and negative likelihood ratios were, respectively, 94%, 88%, 92%, 97%, 93%, 92%, 7.8, and 0.07 for DMS; 87%, 96%, 91%, 97%, 97%, 83%, 22.0, and 0.13 for MIS; and 23%, 91%, 50%, 64%, 80%, 43%, 2.5, and 0.85 for BMI. The results of the present study indicate that the DMS and MIS are almost similar to SGA, in identifying malnutrition in hemodialysis patients, while BMI is not an appropriate index in this regard. In addition, it appears that the DMS is a more appropriate alternative method for SGA in routine hospital assessments