[ impact of malnutrition on the mortality in hemodialysis patients]

ABSTRACT

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.