Nutritional Status in relation to Adequacy of Dialysis in Hemodialysis Patients; a multicenter Study in Egypt

Abstract

End stage renal disease (ESRD) is one of the main health problems in Egypt. Currently hemodialysis represents the main mode of treatment of CKD 5, previously called ESRD or chronic renal failure. In Egypt the estimated annual incidence of ESRD is a round 74 per million and total prevalence of patients on dialysis is 264 per million. Malnutrition is a common problem in dialysis patients, affecting approximately 10-70% of hemodialysis patients. Malnutrition is associated with increased morbidity and mortality in hemodialysis patients. Despite this, the nutritional status of dialysis patients is frequently ignored. Various factors can contribute to incidence of malnutrition such as efficiency of dialysis. Our study sample consisted of 150 HD patients on regular thrice -weekly. HD patients were collected from three different HD unites; El Gomhoria HD unites in Cairo, Ismaillia & El Qantara general hospitals in Ismaillia governorate. In all patients, we recorded HD & medical history stressing on nutritional status, by application of subjective global assessment score and we have done some laboratory investigations as Pre-Bun, Post-Bun, CBC, cholesterol, transferrin, albumin, ESR & CRP .As regard the results, out of 150 patients, 99 were males while 51 were females, their mean age was 51.21± 11.93. The most 3 dominant causes of ESRD were HTN 34 %, DM 16.7%& obstructive uropathy 10% while 26% were due to unknown causes. The average duration on dialysis was 48.07± 40.29 month. out of 150 patients 138 (92%) were malnurished based on their SGA score while based on calculated nPCR 93 patients (62%) were malnurished. 12 patients had a serum albumin less than 3.5 gm/dl. 8 patients had cholesterol level less than 100 mg/dl. 110 patients had a hemoglobin level <10 gm/dl, 17 patients had transferrin< 200 mg/dl, 76 Patients had positive CRP as an evidence of infection. 83patients (55.3%) had inadequate dialysis based on calculated sp kt/v. There was highly positive correlation between Kt/v & nPCR. While SGA score was weakly& negatively correlated to Kt/v. Albumin, cholesterol, transferring & hemoglobin are weakly & positively correlated to Kt/v.