Assessment of Nutritional State in Prevalent Hemodialysis Patients and Its Impact on Quality of Life

Abstract

Despite hemodialysis is the most widely spread renal replacement therapy in Egypt, and despite significant improvements in the quality of dialysis therapy, management of patients maintained on dialysis is very difficult. Many problems face our patients as malnutrition problems, high rates of morbidity and mortality with reduced HRQOL. Regardless financial, social and religious issues which may affect nutrition aspect among our patients, they have many other causes may affect it badly related only to being on hemodialysis like decrease nutrients intake, metabolic derangement, uremic toxins, electrolytes imbalance, inflammation, dialysis associated catabolism, comorbid conditions and depression. Reduced HRQOL also has many different causes which might affect the physical aspect or the mental aspect or both among our patients like inability to work, general health perception, mental illnesses, biological functions, lack of social support and characteristics of the individual and environment. The aim of our study was to assess nutritional state in prevalent haemodialysis patients and to show its impact on quality of life. This was a cross-sectional study which was conducted at the hemodialysis unit in Damanhur Medical National Institute on 100 patients who were maintained on thrice weekly hemodialysis sessions, 4 hours each, using bicarbonate dialysate and heparin anticoagulation. We excluded patients less than 18 years, handicapped, bed ridden as well patients with another uncontrolled debilitating disease like malignancy, active autoimmune disease, active inflammatory condition, decompensated liver disease and heart failure. All patients were subjected to full history taking including detailed history of present illness, medical co-morbidities and duration on dialysis, full clinical examination, dry weight with BMI calculation and laboratory investigations (complete blood picture, urea reduction ratio, serum albumin, serum ferritin, total iron binding capacity, lipid profile, C-reactive protein). They also answered SF12v1 questionnaire (short form questionnaire with 12questions, version1) and MIS (malnutrition inflammation score).