Relationship between the Degree of Malnutrition and Echocardiographic Parameters in Hemodialysis Patients

Abstract

Background: The aim of this study is to investigate the relationship between the degree of malnutrition and inadequate volume control evidenced by echocardiography. Methods: In this study 72 chronic hemodialysis patients were investigated in a cross-sectional manner. The malnutrition score was calculated using Subjective Global Assessment. M-mode echocardiography was performed in all patients. Results: The highest malnutrition score (23.2 ± 1.5 points) and lowest vena cava inferior collapse index (35 ± 2%) were observed in the eccentric left ventricular hypertrophy group. The malnutrition index was found to be in positive relationship with the left atrium diameter and index, left ventricular mass and index, and left ventricular end-diastolic diameter. On the other hand, a negative correlation was detected with the vena cava inferior collapse index. When all parameters that were found to be related to malnutrition were assessed by multivariate analyses, a statistically significant relation was found between the left ventricular end-diastolic diameter and the malnutrition index. Conclusion: The results of our study show that the progressive worsening of the nutritional status follows a parallel course along with the deterioration in the echocardiographic parameters concerning hypervolemia. This in turn suggests that increasing degrees of malnutrition are associated with more profound derangements in the volume status. Volume excess might be a mechanism explaning the increased mortality and morbidity caused by malnutrition in hemodialysis patients. Owing to its cross-sectional design, this study cannot provide unequivocal evidence regarding the cause and effect relationship between volume overload and malnutrition in hemodialysis patients.

Stepwise Increases in Left Ventricular Mass Index and Decreases in Left Ventricular Ejection Fraction Correspond with the Stages of Chronic Kidney Disease in Diabetes Patients

“…In addition to these traditional risk factors, patients with CKD may have other risk factors for increase cardiovascular risk such as inflammation, oxidative stress, anemia, metabolic disorders, calcium-phosphorous disorders, hypervolemia, and structural and functional abnormalities of heart, which may help to explain the high cardiovascular morbidity and mortality in such patients [20–25]. LVH, a common finding in patients with CKD, has been reported to advance with decreases in glomerular filtration rate [3].…”

“…Malnutrition may worsen the outcome of CKD by aggravating existing inflammation and heart failure [27]. Hypoalbuminemia has been correlated with left ventricular structure and function [25, 28, 29]. Kursat et al [25], evaluating the relationship between the degree of malnutrition and echocardiographic parameters in 72 hemodialysis patients, found that the malnutrition index, calculated using Subjective Global Assessment, had a positive correlation with left ventricular mass and index.…”

“…Volume overload may substantially decrease energy and protein intake, suggesting a possible relation between volume overload and malnutrition. In addition, volume overload may increase the diastolic wall stress and in turn cause the development of LVH [25]. Trovato et al [29], also investigating the correlation between heart failure and nutritional status in hemodialysis patients, reported an association between low serum albumin level and decreased LVEF.…”

Left Atrial Diameter and Albumin with Renal Outcomes in Chronic Kidney Disease

“…Fluid overload may be involved in the pathogenesis of malnutrition 21. Previous reports had observed an independent relationship between malnutrition and extracellular fluid volume overload in dialysis patients 10, 22. The mechanisms to explain the correlation between fluid status and nutritional status remains inconclusive.…”

“…In report by Kursat et al, they found the malnutrition index, calculated using Subjective Global Assessment, had a positive correlation with LA diameter (LAD) 10. They explained their findings by inadequate volume control.…”