Prevalence of malnutrition inflammation complex syndrome among patients on maintenance haemodialysis at Muhimbili National Hospital in Tanzania: a cross-sectional study

Abstract

Background Malnutrition, inflammation, and the 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 the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods This was a prospective cross-sectional observational 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 patients’ blood was tested for complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. The Malnutrition Inflammation Score was used to assess 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 (> 4 years) 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, serum albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The presence of MICS was higher in underweight patients and those who had inflammation. Haemodialysis adequacy 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 a longer duration on haemodialysis to be associated with the occurrence of MICS; on the contrary, having hypercholesterolaemia seems to be protective against MICS consistent with the concept of reverse epidemiology. Patients on haemodialysis should be assessed regularly for malnutrition and inflammation and should receive appropriate and timely treatment to reduce the burden of associated morbidity, and mortality to these patients.

Prevalence and predictors of heart failure among patients on maintenance hemodialysis therapy at Muhimbili National Hospital in Tanzania: a cross-sectional study

“…We excluded patients with severe respiratory distress and those who were mentally incapacitated. This study included 160 hemodialysis patients who were part of the study done to determine the prevalence of MICS among patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania [9].…”

“…Each of them graded from 0 (normal) to 3 (severe). MICS was defined as having MIS of 6 or above [9]. Dialysis adequacy was assessed using the Urea Reduction Ratio (URR) calculated as (Pre-dialysis urea − Post-dialysis urea) ÷ Pre-dialysis urea × 100%.…”

Matrix-GLA-Protein and Vascular Calcification: Can Diet Influence the Consequences of Matrix GLA Protein Inactivation? A Review

“…Several experimental studies have demonstrated the potent cytotoxic and procalcific Ca-phosphate crystals in the absence of fetuin-A [156,157] . A decrease in systemic fetuin-A increases systemic calciprotein particles and procalcification of calciprotein particles, thus promoting vascular calcification [158][159][160][161][162] .…”

Erythropoietin Resistant Anaemia among Haemodialysis Patients with Malnutrition Inflammation Complex Syndrome in Dar es Salaam, Tanzania

“…Patients aged 18 years and above who were on maintenance hemodialysis therapy for at least 3 months were eligible for this study. Additional information regarding EPO use and laboratory tests for iron parameters (iron, ferritin, transferrin saturation) were collected for 160 participants who were part of the study that investigated the prevalence and correlates of MICS [14].…”