Factors Influencing Malnutrition in Maintenance Hemodialysis Patients / 대한신장학회잡지

ABSTRACT

BACKGROUND: Malnutrition in maintenance hemodialysis(HD) patients has been referred to underdialysis with low protein intake and to metabolic acidosis. However, the respective effects of underdialysis, protein intake and metabolic acidosis have not been clearly demonstrated. To evaluate the role of the dialysis dose, protein intake and metabolic acidosis on nutrition, we measured the predialysis serum HCO3, pH, serum albumin, PCRn, Kt/V, and BMI in 41 uremic patients on maintenance bicarbonate HD for 66.93+/-51.86 months. Patients with chronic liver diseases, malignancies, diabetes and cachexia were excluded. RESULTS: Mean age was 46+/-13 years; Kt/V, 1.22+/-0.27; PCRn, 0.90+/-0.16g/kg/day; serum albumin, 4.2+/-0.21g/dL; BMI, 20.47+/-2.09kg/m2; HCO3, 18.4+/-2.9mEq/L; Serum albumin showed a significant direct correlation with PCRn(p=0.001), and a significant inverse correlation with serum HCO3(r=0.43, por=20mEq/L. PCRn in the former was 0.94+/-0.6g/kg/day and in the latter 0.80+/-0.14g/kg/day(p<0.05). The role of PCRn appeared to be more important than metabolic acidodsis in determining the serum albumin levels. CONCLUSIONS: In patients hemodialyzed with relatively adequate Kt/V and whose serum bicarbonate levels maintained within mild acidosis range, PCRn may exert a detrimental effect on serum albumin concentration.