The predictive value of malnutrition for functional and cognitive status in elderly hemodialysis patients

Abdulan, Irina Mihaela; Onofriescu, Mihai; Ștefăniu, Ramona; Maștaleru, Alexandra; Mocanu, Veronica; Alexa, Ioana Dana; Covic, Adrian

doi:10.1007/s11255-018-2000-0

Cited by 30 publications

(27 citation statements)

References 19 publications

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“…Indeed, fatigue was reported to affect the ability to prepare meals as indicated by 59% of HD patients reporting “being too tired to prepare meal” as a barrier toward dietary adherence, and this barrier was associated with lower DEI ( r = −0.125, p = 0.002) [ 213 ]. Malnourished HD patients identified using Mini Nutritional Assessment < 19 and SGA > 8 had poor activities of daily living score [ 219 ], suggesting that ability to perform simple daily tasks was affected in these patients.…”

Section: Non-iatrogenic Causes Of Malnutritionmentioning

confidence: 99%

Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review

et al. 2020

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Hemodialysis (HD) majorly represents the global treatment option for patients with chronic kidney disease stage 5, and, despite advances in dialysis technology, these patients face a high risk of morbidity and mortality from malnutrition. We aimed to provide a novel view that malnutrition susceptibility in the global HD community is either or both of iatrogenic and of non-iatrogenic origins. This categorization of malnutrition origin clearly describes the role of each factor in contributing to malnutrition. Low dialysis adequacy resulting in uremia and metabolic acidosis and dialysis membranes and techniques, which incur greater amino-acid losses, are identified modifiable iatrogenic factors of malnutrition. Dietary inadequacy as per suboptimal energy and protein intakes due to poor appetite status, low diet quality, high diet monotony index, and/or psychosocial and financial barriers are modifiable non-iatrogenic factors implicated in malnutrition in these patients. These factors should be included in a comprehensive nutritional assessment for malnutrition risk. Leveraging the point of origin of malnutrition in dialysis patients is crucial for healthcare practitioners to enable personalized patient care, as well as determine country-specific malnutrition treatment strategies.

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Section: Non-iatrogenic Causes Of Malnutritionmentioning

confidence: 99%

Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review

et al. 2020

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“…SGA is a complex assessment of nutritional status and dietary habits that incorporates the analysis of (a) trends in weight, (b) subjective assessment of dietary intake, (c) gastrointestinal symptomatology, (d) estimation of functional impairment and expected energy expenditure and (e) a brief physical examination checking for change in muscle and fat mass or presence of peripheral edema. [23][24][25][26] SGA is usually performed by renal dieticians both in the research setting and in clinical practice with results given based on a semi-quantitative score system to which sometimes laboratory parameters such as serum albumin and total iron-binding capacity are added such as in the malnutrition-inflammation score (MIS score). 20 Though not formally a part of nutritional assessment, depression-related changes in dietary habits may also surface during the interview.…”

Section: What Is Sga?mentioning

confidence: 99%

Subjective global assessment of nutrition, dialysis quality, and the theory of the scientific method in Nephrology practice

Zsom¹,

Zsom

Salim

et al. 2020

Artificial Organs

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In an era of evidence‐based medicine and dialysis performance measures, there is strong motivation to find specific, objective, quantifiable, and reproducible parameters to characterize the clinical condition of chronic kidney disease patients and to present population‐wide statistics that may describe quality of care in dialysis centers. Yet, in the last three decades, several studies demonstrated that while parameters including Kt/V urea, serum phosphorus, parathyroid hormone, serum cholesterol fulfill all these criteria, efforts to optimize these lab parameters failed to improve survival on dialysis. However, subjective assessments of nutrition including subjective global assessment and malnutrition–inflammation score, while not ideally suited for statistical analysis and not optimal from the point of view of scientific methodology due to their general, semi‐quantifiable, subjective nature have, nevertheless, proved themselves as some of the strongest predictors of clinical outcomes in the dialysis population. Where does this paradox leave us? We propose that a deeper understanding of relevance of these variables in the dialysis population may improve appreciation of the clinical situation of individual patients and may result in a paradigm shift from dialysis adequacy to quality dialysis.

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“…Half of the studied population (48% of patients) was functionally dependent and their Barthel index was lower than <80 points, which means that they need support in at least one ADL. Previous studies reported the approximate rates of functional impairment in ADLs (29–52%) [ 11 , 12 ]. The prevalence of disability among patients with chronic kidney disease (CKD), not receiving dialysis, accounts for 18–24% of elderly patients over 65 years.…”

Section: Discussionmentioning

confidence: 99%

Disability of Dialysis Patients and the Condition of Blood Vessels

Gołębiowski

Kusztal

Konieczny

et al. 2020

JCM

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The number of elderly hemodialysis patients is constantly increasing worldwide. This population has a high burden of comorbid conditions, which impair daily activities. The aim of the study was to analyze problems of disability in hemodialysis patients in the context of cardiovascular (CV) complications and vascular condition. In this cross-sectional study, 129 patients (mean age 64.5) were enrolled. The degree of disability in Barthel index (Bi) and 10-year cardiovascular risk (QRISK®3) were assessed. A Mobil-O-Graph monitor was used for measuring hemodynamic parameters. Only 6.2% of patients were professionally active, 19% used a wheelchair for transport, and 16% used crutches. More than half (51%) were independent in everyday activities reaching 80–100 points on Bi. The rest, with Bi < 80, were considered as dependent. The most common causes of disability were CV complications. The independent group (80–100 points) was characterized by significantly lower pulse wave velocity (PWV) and lower QRISK®3 compared to dependent patients. The degree of disability negatively correlated with age, PWV, and QRISK®3. Multivariate logistic regression revealed that disability (Bi < 80) was independently associated with CV events in the past adjusted odds ratio (adj.OR) 4.83 (95% confidence interval (95% CI): 1.74–13.41) and higher PWV adj.OR 1.45 (95% CI: 1.15–1.82). Our results indicate that CV diseases are the most important cause of functional impairment.

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The predictive value of malnutrition for functional and cognitive status in elderly hemodialysis patients

Cited by 30 publications

References 19 publications

Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review

Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review

Subjective global assessment of nutrition, dialysis quality, and the theory of the scientific method in Nephrology practice

Disability of Dialysis Patients and the Condition of Blood Vessels

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