Comparison of Nutritional Parameters among Adult and Elderly Hemodialysis Patients

Abstract

Aim: The aim of this study was to compare the nutritional biochemical parameters, prealbumin levels, and bioimpedance analysis parameters of adult and elderly hemodialysis (HD) patients.Methods: This prospective cross-sectional study included 50 adult HD patients (42.0 % female). Nutritional status was assessed by post-dialysis multifrequency bioimpedance analysis (BIA), serum prealbumin and other nutritional biochemical parameters.Results: Mean age of patients was 57.4±15.1 years (range: 30-83 years) and mean dialysis duration was 68.3 ± 54.5 months (range: 3-240 months). When the patients were divided into two groups according to age of patients (<65 and ≥65), prealbumin (p=0.003), blood urea nitrogen (BUN) (p=0.000), serum creatinine (p=0.013), albumin (p=0.016), protein catabolic rate per normalized body weight (nPCR) (p=0.001), intracellular water (ICW)/total body weight (0.003) , body fat mass (p00.000), lean body mass (p=0.031), lean dry mass (p=0.001), illness marker (p=0.005), basal metabolism (p=0.007), body mass index (BMI) (p=0.028), body fat mass index (BFMI) (p=0.000), fat free mass index (FFMI) (p=0.040) values were significantly different between the groups. In the elderly patients (age ≥65), body fat mass, illness marker, BMI, BFMI were higher compared to adult patients (age <65). Additionally, in the elderly patients, prealbumin, BUN, creatinine, albumin, nPCR, ICW/ total body weight, lean body weight, lean dry weight, basal metabolism and FFMI were lower than adult patients.Conclusions: Our results indicate that BFMI were higher, albumin, prealbumin, nPCR and lean body mass and FFMI were lower in elderly patients compared to adults. These results imply that elderly HD patients may be prone sarcopenic obesity and may require special nutritional support.

Impact of BMI Variations on Survival in Elderly Hemodialysis Patients

“…4 Elderly hemodialysis patients present more frequently criteria for protein-energy wasting than younger ones. 7,8 The impacts of several nutritional markers on survival have been already studied in this population but, to our knowledge, the association between BMI changes over time and survival has never been studied.…”

“…[21][22][23] However, these studies were not focused on elderly patients who have specific wasting patterns. [7][8][9] The association between weight gain and poor survival has been already found in elderly non-CKD patients. 24 Furthermore, a recent trial in elderly patients starting dialysis has shown that not only weight loss but also weight gain before initiation of dialysis was associated with poor survival.…”

“…7,8 In fact, many risk factors for wasting are specific to the elderly; e.g., loss of autonomy, cognitive dysfunction, isolation, depression, and decrease of sensory functions. 9 Furthermore, wasting has been found associated with poor survival in elderly hemodialysis patients [10][11][12][13] and correlated with poor functional status, which has a direct impact on autonomy.…”

The Nutritional Status of Patients Starting Specialized Predialysis Care

“…10,11 However, our data are in line with findings in patients on hemodialysis in whom age is also a risk factor for poor nutritional status. 6 Patients with moderate protein-energy wasting had a lower BMI than those without, indicating that proteinenergy wasting is related to BMI. However this does not mean that patients with higher BMI are not at risk for malnutrition, as illustrated by 16 patients in our cohort with a BMI .25 kg/m 2 who nevertheless had moderate protein-energy wasting.…”

“…5 In particular, elderly patients (aged .65 years) on hemodialysis are at increased risk for an impaired nutritional status. 6 Besides the presence of malnutrition at initiation of dialysis, also unintentional weight loss in hemodialysis patients is associated with increased mortality. For example, results from a retrospective cohort study including 217 maintenance hemodialysis patients showed that patients with more than 5% unintended weight loss were at increased risk for mortality compared with patients without weight loss (hazard ratio of 3.0 [1.2-7.5]).…”