Clinical and biochemical assessment of nutritional status in patients with chronic renal failure on regular haemodialysis

Malnutrition is common in patients with chronic renal failure [CRF] on regular haemodialysis [HD]. The aim of this study is to evaluate the extent of this problem in haemodialysis unit in Assiut University Hospitals. Sixty male patients with CRF on regular HD and 20 age and sex matched controls were enrolled in this study. All patients and controls were subjected to complete history, physical examination and estimation of anthropometric measurements [body weight [wt], body mass index [BMI], midarm circumference [MAC] and triceps skin fold [TSF]. The following investigations were done for all subjects including; peripheral hemogram, kidney functions, lipid profile, serum phosphorus [P], calcium [Ca], albumin, transferrin and ferritin, in addition to serum leptin and C-reactive protein [CRP]. The patients were classified according to uraemic score into 3 groups [A; 13 patients, B; 34 patients and C; 13 patients]. Cases were also classified, according to subjective global assessment score [SGA] of nutritional status into group A [no malnutrition, 6 patients], group B [mild to moderate malnutrition, 35 patients] and group C [severe malnutrition; 19 patients]. According to serum albumin level also patients were classified into group A [serum albumin> 40 g/L; 27 patients], group B [serum albumin 30-40 g/L; 30 patients] and group C [serum albumin< 30 g/L, 3 patients]. The mean values of wt, BMI, TSF, MAC, albumin and transferrin were significantly lower in patients than controls [P<0.001, 0.001, 0.001, 0.001, 0.01 and 0.001 respectively]. Mean levels of serum P, leptin and ferritin were significantly higher in patients than controls [P<0.001 for all]. Mean values of wt, BMI, TSF, MAC and Hb were significantly lower in group B and C than group A when patients were classified according to SGA score [P< 0.05 for B vs A and P<0. 001, 0.00!, 0.001, 0.01 and 0.05 for C vs A]. The mean values of wt, BMI, TSF, MAC, Hb and serum leptin were also significantly lower in group C than B [P<0. 001, 0.01, 0.01, 0.05 and 0.05 respectively] but mean values of ferritin were significantly higher in malnourished patients group B and C than group A [P<0.001 for each]. Mean values of TSF were significantly lower in group C than A [P<0. 05] and mean values of wt, BMI, and TSF were significantly lower in group C versus B [P<0.05 for all] when patients were classified according to uraemic score. 75% of patients had positive CRP and 20% had lymphopenia. Positive correlations were found between Hb and wt, BMI and MAC [F<0.05 for all]. Positive correlation was found between ferritin and CRP [P<0. 05] and negative correlations with BMI, TSF and MAC [P<0. 01, 0.05 and 0.05 respectively]. Malnutrition was common in patients with CRP on regular HD. Anthropometric measurements were lower in malnourished patients than well-nourished patients. Hyperleptinaemia may participate in the pathogenesis of uraemic anorexia. Inflammation may play a role in occurrence of malnutrition in CRF patients. We recommended dietary education of patients with CRF and follow up patients with anthropometric measurements. Further studies are needed to substantiate role of leptin in the development of malnutrition

Sex hormone profile in male diabetics, its relationship with sexual dysfunction

To investigate endocrinological changes associated with diabetes mellitus, serum total and free testosterone [T], estradiol [E [2]], lutenizing hormone [LH], follicle stimulating hormone [FSH] and prolactin [Prl] were determined in 39 male diabetic subjects [7 with type I and 32 with type II diabetes]. In addition to 14 healthy males of comparable age. Serum total and free T were significantly reduced but serum E [2], LH and Prl were significantly increased while FSH exhibited non-significant increase in diabetic subjects compared with healthy males. Neither did the type of diabetes nor its duration affect the hormonal levels. Similarly, no significant differences could be observed in the hormonal profiles between complicated and non-complicated diabetics. However, serum total and free T were significantly decreased in impotent compared to non-impotent diabetics. Serum total T levels exhibited a significant inverse correlation with blood glucose levels, but were not correlated with the age of the patients or with the duration of disease. The results of the present work demonstrated the presence of changes in sex hormone levels in male diabetics that could contribute to sexual dysfunction. Hyperglycaemia seems to be one of the causative factors for such changes and the use. of oral antidiabetic agents may be an added factor