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

ABSTRACT

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