[ impact of malnutrition on the mortality in hemodialysis patients]

The mortality rate is still elevated in hemodialysis population despite the advances in the dialysis techniques. In fact dialysis patients are exposed to many risk factors including cardiovascular diseases [CVD] accounting for 50%, diabetes mellitus and infections. Recent studies have focused on the role of malnutrition [MN] as an additional risk factor in increasing the mortality rate, since malnutrition is a frequent complication in chronic renal failure and hemodialysis patients. To study the relationship between malnutrition and increased mortality rate in hemodialysis patients at Al - Assad University Hospital. A cross sectional study was carried out in hemodialysis unit at Al- Assad University Hospital, Damascus - Syria, in February 2008 then the patients were followed for 24 months. There were 68 patients [43 men, 25 women]. Nutritional status was assessed by Malnutrition Score [MS]. Biochemical nutritional parameters including serum albumin, total protein, total cholesterol, serum creatinine, serum phosphorous, hemoglobin, CRP and blood urea before and after the dialysis session were measured. Some anthropometric measurements such as dry weight, body mass index, biceps, triceps and scapular skinfold thickness to evaluate the fat store, mid arm circumference and mid arm muscle circumference were also performed to assess the muscular mass. According to MS, 51.4% were well nourished, [48.6%] were malnourished. The mortality rate was elevated [27.9%]. Kaplan Meier analysis showed high survival rate in well nourished patients [Log Rank 4.89], [P = 0.027]. Multiple logistic regression analysis showed that the predictor factors of mortality were: Malnutrition Score [P = 0.010], low serum albumin [P = 0.001], mid - arm muscle circumference [MAMC] [P = 0.025] and vintage [years on dialysis] [P = 0.03]. The mortality rate as well as malnutrition was highly elevated in our study as many international studies, the study showed also that malnutrition was correlated with the high mortality rate; therefore it can be added to the other risk factors increasing the mortality rate such as cardiovascular diseases.

Prevalence of metabolic syndrome in hemodialysis patients

Background: Metabolic Syndrome [MS] is an important risk factor for cardiovascular and chronic kidney diseases [CKD] in the general population. It is known that cardiovascular diseases are the first cause of death in hemodialysis patients. MS is associated with high rate of morbidity and mortality in general population as well as in hemodialysis patients. Objective: the aim of this study is to evaluate the prevalence of metabolic syndrome in hemodialysis patients in AL - Assad University Hospital – Damascus, using the Cholesterol Education Program Adult Treatment Panel III [NCEP ATP III 2005] criteria defined as the presence of any three of the following five traits: Waist circumference in men >102 cm and > 88 cm in women, Serum triglycerides = 150 mg/dL, Serum HDL cholesterol < 40 mg/dL in men and < 50 mg/dL in women, Blood pressure = 130/85 mmHg, Fasting plasma glucose = 100 mg/dL. Patients and methods: A total number of 78 patients undergoing regular hemodialysis were enrolled in this cross-sectional study carried out during six months [July 2009-Januray 2010]. There were [51 male/27 female], mean age was 17+ 56 years, and mean time on dialysis was 54 + 59.5 months minimum 5 months. Physical examination was performed and medical history was taken, blood samples were collected in the beginning of the dialysis session for the total cholesterol, high-density lipoprotein cholesterol level [HDL], low density lipoprotein cholesterol level [LDL], triglyceride, fasting blood sugar, serum creatinine, serum albumin. Waist circumference, triceps skinfold thickness [TSF] and mid-arm- circumference [MAC] were measured, body mass index [BMI] was calculated. Results: The total prevalence of metabolic syndrome was 43.5 %, higher in the first 12 months of dialysis [64.7%] than after 48 months [46.2 %], men were more exposed [52.94 %] than women and [47.05 %], MS patients were older than patients without MS, and had better nutritional indicators [TSF, MAC, BMI], the frequency of MS risk factors was similar for blood pressure, waist conference, fasting blood sugar and serum triglyceride [76.4], the prevalence of central obesity was [31.9%] of the patients study and 52.5% were overweight and obese. Conclusion: Metabolic syndrome is highly prevalent in hemodialysis population, 43.5% of the patients study met the criteria of MS, men and older age were more affected. New dialysis patients were more affected than old dialyzed patients, patients with MS were wellnourished. Key words: Metabolic syndrome, hemodialysis, obesity, cardiovascular diseases