Evaluation of Malnutrition and Its Association With Biochemical Parameters in Patients With End Stage Renal Disease Undergoing Hemodialysis Using Subjective Global Assessment

Abstract

Background:Malnutrition is a common problem in patients with end stage renal disease (ESRD) undergoing hemodialysis that increases morbidity and mortality rate in them. Subjective global assessment (SGA) is a tool used by health care providers to assess nutritional status in these patients. In addition, biochemical parameters are used to assess the nutritional status in all people.Objectives:In this study, we evaluated the nutritional status of patients with ESRD undergoing hemodialysis using SGA and assessed probable association between biochemical parameters and malnutrition in this population.Patients and Methods:Using SGA, the nutritional status of 105 patients (60 males and 45 females) of two dialysis centers in Sari, Iran, was evaluated during years 2007-2008. It is a semiquantitative scoring system that has seven variables derived from medical history and physical examination. The biochemical parameters including hemoglobin, albumin, cholesterol, BUN, and creatinine were also measured.Results:Among 105 patients, 98 (93.33%) patients consisted of 56 males and 42 females had mild to moderate malnutrition and 3 (2.86%) women had severe malnutrition. In addition, all of the patients without malnutrition were men. We found significant association between patient’s sex and the SGA score (P = 0.03) but no significant association was seen between age and duration of hemodialysis with SGA score. In addition, we did not find significant association between the measured biochemical parameters and malnutrition.Conclusions:According to high prevalence of malnutrition in our patients with ESRD undergoing hemodialysis, periodic assessment of nutritional status is necessary in them. Meanwhile we found SGA as the best tool to assess nutritional status in patients with ESRD undergoing hemodialysis, because it can recognize various degrees of malnutrition that may remain undetected by a single laboratory assessment.

Evaluation of nutritional status with anthropometric measurements and MQSGA in geriatric hemodialysis patients

“…60% of our elderly MHD patients had malnutrition (36.4% of patients had at mild-to-moderate and 23.6% of patients had at severe level) and MQSGA score was elevated with patients’ age. Even though, previous studies showed that malnutrition was significantly more frequent in women [12, 13], our study no significant correlation between malnutrition and gender. In elderly patients social isolation, cognitive dysfunction in maintaining basic nutritional requirements and depression may result in malnutrition.…”

Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients

“…28,29 A previous study by Jones et al 24 found significant differences in midarm circumference, midarm muscle circumference, and serum creatinine and CRP concentrations, but not serum albumin concentrations, between patients classified as SGA A (WN) and B (mildly to moderately MN). In addition, they showed that the composite nutrition score was associated with the 3-point SGA score, 7-point SGA score, BMI, midarm circumference, and triceps skinfold, except for serum albumin concentrations.…”

The screening score of Mini Nutritional Assessment (MNA) is a useful routine screening tool for malnutrition risk in patients on maintenance dialysis

“…For these reasons, SGA is recommended by European Renal Best Practice as a good tool to screen nutritional status in the elderly [10]. However, SGA still can be criticized for its subjectivity, and thus potential problems for reproducibility [28,29], and several authors report different results on the association of SGA with more objective nutritional markers [30,31]. Further SGA takes some time and expertise to be evaluated, making it less suitable in fact for routine use as a regular screening tool in a busy dialysis unit.…”