comparative analysis of the association of chronic inflammation versus no inflammation on the nutritional status of patients on chronic maintenance hemodialysis

ABSTRACT

To assess the association of chronic inflammation on the nutritional status of patients on Chronic maintenance hemodialysis. This cross-sectional comparative study was performed at department of Medicine Fauji Foundation Hospital Rawalpindi. Patients having chronic renal failure who were on regular maintenance hemodialysis for more than 6 months were included in the study. Ultrasound examination was done to confirm the presence of renal parenchymal disease and shrunken kidneys. The level of C-reactive protein was measured as indicator of inflammation and serum albumin, cholesterol level, mid-arm circumference, triceps skin fold thickness, subscapular skin fold thickness and body mass index [BMI] were used as the assessment tools to evaluate the influence of inflammation on the nutritional status in patients. Patient in two groups with positive or negative CRP were compared regarding the effects of inflammation on nutritional parameters. Out of 30 patients, 13 [43.3%] had evidence of inflammation with positive CRP and a mean BMI of 19.2 +/- 3.3 whereas the CRP negative group had a mean BMI of 24.9 +/- 1.5. Regarding nutritional parameters, Triceps Skin Fold Thickness, Subscapular Skin Fold Thickness, mid-arm circumference and serum albumin were also statistically low in CRP positive patients although serum cholesterol levels did not differ significantly in our study. The CRP positive patients therefore were malnourished as compared to the CRP negative group. Patients with end stage renal disease on chronic dialysis with evidence of inflammation are more at risk of malnutrition. Although there is no standardized strategy for the treatment of chronic inflammation in these patients so far but this area needs further research to improve outcome in these patients