Impact of malnutrition, inflammation, and atherosclerosis on the outcome in hemodialysis patients

Abstract

Malnutrition, inflammation, and atherosclerosis are significant problems in patients on hemodialysis. A prospective, observational study in 100 hemodialysis patients for 2 years was conducted. The primary outcomes were hospitalizations and mortality at the end of 2 years. The mean age was 61 ± 11.3 years and 69% were male. Seven patients did not complete the study (five underwent transplant and two were shifted to other units). Serum albumin was significantly lower in malnourished patients at 6 months from the beginning of the study period (3.58 vs. 3.79 g/dl, P = 0.001). Malnutrition based on subjective global assessment (SGA) was seen in 30 (32%) patients: mild to moderate in 27 (29%) and severe in 3 (3%). Inflammation was seen in 73 (78.5%) patients and intimal-medial thickness of >1.1 mm indicating significant atherosclerosis was seen in 73 (78.5%) patients. Modified SGA score and malnutrition-inflammation score (MIS) were significantly more in the malnourished group. Statistically significant association was seen between hospitalization and mortality in the malnourished population, and the odds ratio of death in malnourished patients was 9.83 (95% confidence interval: 2.8–34.3, P < 0.001). There was a moderate correlation between malnutrition assessed by modified SGA and MIS score (r = 0.54, P < 0.001). Mortality rate was 37% in patients with mild to moderate and 67% in severe malnutrition. Hospital admission was seen in 43 (46%) patients and was significantly more common in malnourished compared to well-nourished patients (77% vs. 32%, P < 0.001). Multiple logistic regression analysis showed that malnutrition by Modified SGA was the only significant variable associated with mortality at 2 years, and addition of MIS score did not improve the predictive ability of the model to modified SGA. We recommend the use of modified SGA and serial serum albumin to monitor nutrition in hemodialysis patients.

Optimal blood pressure for the minimum all-cause mortality in Chinese ESRD patients on maintenance hemodialysis

“…The namesake components of the MIA syndrome have been known for decades as predictors of a short life expectancy for the MHD patients [24]. Indeed, the mortality rate within 2 years in an Indian MHD cohort was 0, 8.7, 13.0 and 45.0% when none, one, two and three of these components were present, respectively [25]. In general agreement, we found that the pre-dialysis Scr, hs-CRP and pre-dialysis SBP were significant determinants of all-cause mortality as each may serve as a surrogate marker for the individual component of the MIA syndrome [26].…”

Clinical measurement properties of malnutrition assessment tools for use with patients in hospitals: a systematic review

“…On the other hand, the studied tool was found to correlate with anthropometric measures and biochemical measures in a variety of patient populations in Asia and Europe [ 45 , 64 ]. Moreover, SGA with category B or C predicts longer hospital stays [ 45 ] and mortality [ 65 ].…”

Assessment of Relationship Between Nutritional Status and Handgrip Strength in Hemodialysis Patients

“…In this study, we conducted the assessment of the relationship between the nutritional status and muscle strength in patients undergoing HD; according to SGA, 73.3% of patients were well-nourished and 26.7% of patients were moderately malnourished. According to Kirushnan et al, among 93 HD patients who participated in the study, 68% of patients were well-nourished and 32% of patients were undernourished (there were 29% of moderate and 3% of severe malnutrition cases) [13]. Koor et al found that in a study that included 190 HD patients, according to SGA, 8.4% of patients were well-nourished, 47.4% of patients were mildly malnourished and 44.2% of patients were moderately malnourished [14].…”