The association of nutrition with interdialytic weight gain and depressive disorder in hemodialysis patients

Abstract

Department of internal medicine, college of medicine, the catholic university of koreaMalnutrition was reported to occur in 23-76% and known as an important predictor of increased mortality in maintenance hemodialysis (HD) patients. This study was performed to evaluate the association of nutrition with interdialytic weight gain (IDWG) and depression in HD patients. Sixty-five HD patients for at least 3 months were enrolled. We investigated malnutrition by OSND (Objective score of Nutrition on dialysis) score and depressive disorder by Montgomery depression rating scale and Hamilton depression rating scale. We compared the clinical and biochemical profiles according to the presence of malnutrition. Mean age of the patients was 55.7712.6 years and patients with diabetes accounted 55.4%. Mean duration of HD was 36.2732.0 (4-129) months. Depressive disorder was diagnosed in 21 (32.3%), Malnutrition (OSND scoreo22) in 24 (36.9%) and large IDWG (41 kg/day) in 40 (61.5%) out of the 65 HD patients. Patients with malnutrition had lower incidence of large IDWG (45.8% vs 70.7%, p¼ 0.046) and depression (19.5% vs 54.1%, p¼ 0.004) than those without. BMI (21.273.0 vs 23.473.0 kg/m 2 ,p¼0.006), TSF (triceps skin fold thickness, 8.874.2 vs 15.076.2 mm, po0.001), MAC (mid-arm circumference, 23.672.7 vs 26.473.0 cm, p¼ 0.001), serum albumin (3.670.3 vs 3.870.2 g/dL, p¼0.029) and total cholesterol (142.5729.2 vs 169.7731.2 mg/dL, p¼ 0.001) were also lower in patients with malnutrition, compared to the patients without malnutrition. There was no difference in age, gender, diabetes and HD duration between the two groups. In multivariate analysis, Depressive disorder was an independent risk factor for malnutrition.Fig. Multivariate analysis of risk factors for malnutrition in chronic HD patients (n¼65) (R 2 ¼ 0.285). In conclusion, we suggest that the depressive disorder may be considered in HD patients at the time of the assessment of nutritional status in maintenance HD patients. In addition, it is hard to use large IDWG as an indicator of nutrition in maintenance HD patients.http://dx.Acid-base unbalance is most common problem in severe ill patient, especially in condition of abnormal renal function state. Acid-base unbalances are respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis. Metabolic acidosis is frequently appeared in clinical state. Arterial blood gas analysis is considered as a basic test to the intensive care unit patient and emergency state. Recently some researches were done, comparing with arterial blood gas analysis and venous blood gas analysis. Because of venous blood sampling is safer than arterial blood gas analysis, and beside not so different among them for detecting pH, pCO 2 , HCO3, except pO 2 measuring. This research was done in emergency room, and for explaining no different between arterial blood gas analysis and peripheral blood gas analysis result in acid-base unbalance state patient. Especially in kidney functions decreased state. : The study was done from March, ...