Prevalence of nutritional risk and its impact on functional recovery in older inpatients on maintenance hemodialysis: a retrospective single-center cohort study

Abstract

Background: Poor nutritional status and functional impairment are common in patients with end-stage renal disease (ERSD) on maintenance hemodialysis (MHD). Although nutritional status is associated with functional dependence and rehabilitation outcome in several diseases, this association remains unclear in patients with ESRD. The aim of this study was to investigate nutritional risk and its impact on rehabilitation outcomes in MHD inpatients who required rehabilitation. Methods: A retrospective cohort study was performed in 57 consecutive MHD inpatients aged 65 or older who had undergone rehabilitation. The Geriatric Nutritional Risk Index (GNRI) was used to assess nutritional risk and was calculated from height, dry body weight, and serum albumin level at the start of rehabilitation. Nutritional risk was defined as a GNRI < 91.2. The activities of daily living were used as a measure of rehabilitation outcome and were assessed by the Barthel Index (BI) at the start of rehabilitation and discharge. The Mann-Whitney U test and multiple regression analysis were performed. In the multiple regression analysis, BI gain was the dependent variable and age, sex, and GNRI were the independent variables. Results: The study included 34 men and 23 women. Mean (± SD) GNRI was 79.8 ± 9.9. Of the 57 patients, 50 (87.7%) were identified as having a nutritional risk and 7 were not. The gain in BI was significantly higher in patients without nutritional risk (median 50 vs. 10, p = 0.03). Multiple regression analysis showed GNRI was associated independently with BI gain (R 2 = 0.14, β = 0.29, p = 0.03). Conclusions: The majority of the MHD patients who underwent rehabilitation had a nutritional risk. Nutritional risk was associated independently with functional recovery.