Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis in Tanzania: A Cross-Sectional Study

Abstract

Background: Malnutrition, inflammation and combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated on the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. Methods: This was a cross-sectional descriptive study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and some laboratory investigations were done. The Malnutrition Inflammation Score was used to access MICS and its severity. Data analysis was done using the SPSS 20 software.Results: Of the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%). Long-term haemodialysis (>4years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), p<0.05]. Hypercholesterolaemia was a negative predictor of MICS [AOR 0.11 (95% CI: 0.01-0.97), p<0.05]. Patients with MICS had significantly lower mean body mass index, albumin, total cholesterol, transferrin, haemoglobin and serum creatinine levels. Nutritional status and inflammation significantly associated with MICS; adequacy of dialysis did not correlate with MICS.Conclusion: Malnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown longer duration on haemodialysis to be associated with the occurrence of MICS; to the contrary, having hypercholesterolaemia seems to be protective against MICS rhyming well with the concept of reverse epidemiology. Patients on haemodialysis should to be regularly assessed and accordingly treated for malnutrition and inflammation which if left unattended, compounds morbidity and mortality among these patients.