Evaluation of Nutritional Biochemical Parameters in Haemodialysis Patients Over a Ten-Year Period

Abstract

INTRODUCTION Protein-energy malnutrition affects a high percentage of patients with chronic kidney failure and is associated with increased morbidity and mortality rates. Factors that directly contribute to malnutrition in these patients are mainly alterations in protein-energy metabolism, hormonal derangements, infections, and a reduction in food ingestion because of anorexia, nausea and vomiting produced by uraemic toxicity. After beginning renal replacement therapy, patients usually find that most of the evident symptoms of uraemia abate or disappear altogether. As a result, their appetite improves and they begin to feel better. However, various studies show that the prevalence of protein-energy malnutrition in haemodialysis patients still remains high. In fact, 23−76% of patients undergoing haemodialysis generally suffer from malnutrition (1−3). In recent years, research on haemodialysis patients has pinpointed an association between signs of malnutrition, particularly a decrease in plasma albumin and an increase in morbidity and mortality (4, 5). Moreover, predictors of the low survival of these patients include atherosclerosis (aggravated by high blood pressure and smoking), oxidative stress, inflammation and malnutrition (6, 7), combined with a low body mass index (BMI), altered lipoprotein profiles and high lowdensity lipoprotein (LDL) levels (8−11).The objective of this research study was to assess the nutritional state of the patients at a haemodialysis unit by evaluating biochemical parameters (total proteins, albumin, cholesterol and plasma transferrin) and anthropometric parameters of weight, height and BMI. The patients were monitored over a period of ten years in order to determine whether they suffered disorders that could be caused by a state of malnutrition directly related to the length of the haemodialysis treatment.

Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort

“…This predominant inflammatory condition of HD patients also explains the results we found in our study in relation to serum protein (95% CI 2.073–10.341). Elevated protein catabolism is common in patients with ESRD and its underlying etiology includes other complications, such as metabolic acidosis, uremia, systemic inflammation, anemia and other factors that further worsen kidney function and provide greater risks of mortality [ 42 , 43 ].…”

“…In addition, hypoalbuminemia is considered a marker of malnutrition and a strong predictor of death in these patients. However, serum albumin levels should be used with caution as nutritional markers for these patients, because low levels of this protein in HD patients are also associated with malnutrition, inflammation and, consequently, with other complications such as anemia secondary to ESRD [ 42 , 45 , 46 ].…”

Malnutrition and clinical outcomes post alloSCT

“…Malnourished patients were 3.8 times more likely to be admitted to ICU, which in turn was associated with increased LOS. Studies in other patient groups have provided evidence of associations between ICU admission, prolonged LOS and deteriorating nutritional status [24][25][26] . The impact on healthcare costs and the implications for clinical practice should also be considered.…”

Mapping the global research landscape on malnutrition for patients with chronic kidney disease: a visualization analysis

“…However, numerous reports indicate that the incidence of protein-energy malnutrition remains elevated in people undergoing hemodialysis, ranging from 23 to 76%. This prevalence is influenced by age, dialysis treatment effectiveness and comorbidities [ 75 , 76 ].…”