Assessment of nutritional status in chronic hemodialysis patients at the galayanivadhana hemodialysis unit.

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 circumference. 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, education al 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 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.

Development of Thai quality-of-life questionnaires for patients with chronic renal failure.

Chronic renal failure (CRF) is one of a number of major diseases that seriously affects quality-of-life (QOL). In this study, we developed a disease-specific QOL questionnaire in Thai for CRF. A list of items important to QOL of CRF patients was created by interviewing five patients, four nephrologists, and four nephrology nurses to identity items that affect patients’ QOL. Additional items were sought from English questionnaires. Another 50 CRF patients were then interviewed to determine the importance of each item by rating then on a scale of 1 (minimally important) to 5 (extremely important). Patients were also encouraged to add items which were not on the list. For each potential item, a frequency-importance score was calculated by adding each patient’s score. A combination of factor analysis and clinical judgment was then used to develop the final questionnaire, with questions scored on the 5-point Likert scale (ranging from “none of the time” to “all of the time”). Psychometric properties were subsequently evaluated in CRF patients at Siriraj Hospital. The validity of the questionnaire was assessed using the relationship between QOL questionnaire scores and the severity chronic renal failure assessed by the adequacy of dialysis diochemical parameters such as serum albumin, urea and creatinine and nurses’ or patients’ global assessment. Reproducibility and internal consistency were examined twice by interviewing 40 hemodialysis patients who came to hemodialysis clinic and had follow-up one week later. The final questionnaire consisted of 24 questions in five domains (physical symptoms, fatigue, psychological, social and emotional). The scores for all corrected strongly with nurses’ and patients’ assessment scores. The reproducibility of the questionnaire was high (intraclass correlation coefficient between 0.60 and 1.00 for the five domains except for the social domain). A high internal consistency in the questionnaire was found using the o-coefficient of Cronbach (ranging between 0.50-0.86 for the two tests). This questionnaire appears to be valid and reliable for assessing CRF patients.

Non-oliguric renal failure in aminoglycoside nephrotoxicity.

Clinical and laboratory data were reviewed on 35 patients with acute renal failure associated with aminoglycoside administration. The diagnosis of nephrotoxicity was based on azotaemia both with or without a decline in the volume of urine. Clinical nephrotoxicity in these cases most likely occurred in association with surgery, advanced age, diabetes mellitus, jaundice and recent exposure to aminoglycosides. Twenty one of the 35 patients were non-oliguric. The duration of established renal failure after administion of aminoglycosides varied from 4 to 16 days. The common causative drugs were gentamicin (1.5-5 mg/kg/day) and kanamycin (1 gm/day) respectively. The maximum creatinine was 15 mg/dl. Conservative management of renal failure included withdrawal of aminoglycosides or adjusting the dose according to renal function, treatment of underlying diseases and provision of adequate hydration. Sixteen patients improved with normal serum creatinine within 7 days to 2 months after the onset of renal failure. Non of non-oliguric patients required dialysis treatment. Five patients died from septicaemia.