Prevalence of malnutrition and associated factors in hemodialysis patients

Freitas, Ana Tereza Vaz de Souza; Vaz, Inaiana Marques Filizola; Ferraz, Sanzia Francisca; Peixoto, Maria do Rosário Gondim; Campos, Marta Isabel Valente Moraes

doi:10.1590/1415-52732014000300009

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Original Articles • Rev. Nutr. 27 (3) • May-Jun 2014 • https://doi.org/10.1590/1415-52732014000300009 copy

Prevalence of malnutrition and associated factors in hemodialysis patients¹ 1 Article based on doctoral dissertation of ATVS FREITAS intitled "Prevalência e fatores associados à desnutrição e à obesidade abdominal em pacientes em hemodiálise na cidade de Goiânia-GO". Universidade Federal de Goiás; 2011

Prevalência de desnutrição e fatores associados em pacientes em hemodiálise

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To assess the prevalence of malnutrition and associated factors in hemodialysis patients.

METHODS:

This is a cross-sectional study of 344 hemodialysis patients from Goiânia, Goiás aged 18 years or more. The dependent variable, malnutrition, was investigated by the Subjective Global Assessment. The independent variables included socioeconomic, demographic, and lifestyle data, clinical history, and energy and protein intakes. The patients underwent anthropometric measurements and laboratory tests. Multiple Poisson regression determined the associated factors (p<0.05).

RESULTS:

Mild or moderate malnutrition was found in 22.4% of the patients. Malnourished patients had lower body mass index, mid-arm muscle circumference, percentage of body fat, serum creatinine (p<0.001), and normalized protein nitrogen appearance (p=0.001). Multivariate analysis identified the following factors associated with malnutrition: age between 19 and 29 years (PR=1.23, 95%CI=1.06-1.43), family income less than 2 minimum salaries (PR=1.13, 95%CI=1.01-1.27), hemodialysis vintage >60 months (PR=1.08, 95%CI=1.01-1.16), Kt/V>1.2 (RP=1.12, 95%CI=1.03-1.22), calorie intake <35 kcal/kg/day (PR=1.22, 95%CI=1.10-1.34), and normalized protein nitrogen appearance <1.0 g/kg/day (PR=1.13, 95%CI=1.05-1.21).

CONCLUSION:

The prevalence of malnutrition in this population was high, corroborating the literature. The prevalence was higher in patients aged less than 29 years and those with low family income, longer hemodialysis vintage, higher Kt/V, and inadequate protein and calorie intakes. Strategies to reverse this situation should include more nutritional care.

Malnutrition; Nutrition assessment; Renal dialysis

Variables		Total	Nourished				Malnourished			p ^*
Variables		Total	n=267 (77.60%)				n=77 (22.40%)			p ^*
			n=267 (77.60%)				n=77 (22.40%)

Gender										<0.929^**
Males (n/%)	204	(59.30)	158	(77.45)			046	(22.55)
Females (n/%)	140	(40.70)	109	(77.86)			031	(22.14)
Age (years)	49.33 ± 13.76		50.07 ± 12.94				46.75 ± 16.09			<0.062^**
HD vintage (months)	43 (24.00 - 78.75)		42 (24 - 72)				48 (25 - 97.5)			<0.092^**
Kt/V	1.59 ± 0.39		1.55		± 0.38		01.73		± 0.38	<0.001^**
CRF etiology (n/%)										<0.741^**
Hypertensive nephropathy	130	(37.70)	100	(37.45)			030	(38.96)
Glomerulonephritis	67	(19.50)	55	(20.60)			012	(15.58)
Diabetic nephropathy	54	(15.70)	39	(14.61)			015	(19.48)
Not determined	26	(7.60)	22	(8.24)			04	(5.19)
APKD	24	(7.00)	19	(7.12)			05	(6.49)
Others	43	(12.50)	32	(11.99)			011	(14.29)
Comorbidities (n/%)										<0.427^**
High blood pressure	228	(66.40)	177	(66.29)			051	(66.23)
Diabetes	12	(3.60)	8	(3.00)			04	(5.19)
High blood pressure + DM	40	(11.70)	28	(10.49)			012	(15.58)
Others	13	(3.40)	1(4.12)				02	(2.60)
Inexistent	51	(14.90)	43	(16.10)			08 (10.39)
Weight (kg)	64.04 ± 12.85		67.25		± 12.28		52.91		± 7.46	<0.001^**
BMI (kg/m²)	23.19 (20.72-26.03)		24.72		±	3.90	20.00		± 2.55	<0.001^**
MAMC										<0.001^**
<5^th percentile	82 (23.80)		37	(13.90)			045	(58.40)
=5^th percentile	262	(76.20)	230	(86.10)			032	(41.60)
Body fat (%)	29.60 ± 8.80		31.55		±	7.93	22.83		± 8.35	<0.001^**
LBM (kg)	44.73 ± 8.84		45.85		±	8.95	40.84		± 7.25	<0.001^**
Serum albumin (g/dL)	4.01 (4.0 - 4.3)		4.13		±	0.27	04.12		± 2.69	<0.642^**
Pre-HD urea (mg/dL)	110.84 ± 27.52		112.13		± 28.09		106.38		± 25.14	<0.106^**
Serum creatinine (mg/dL)	9.50 ± 2.62		9.77		±	2.60	08.57		± 2.53	<0.001^**
Energy intake (kcal/kg IW)	26.05 ± 6.64		26.25		±	6.86	25.33		± 5.80	<0.282^**
nPNA (g/Kg IW)	1.03 ± 0.27		1.05		±	0.27	00.94		± 0.22	<0.001^**

	Sample distribution				Prevalence		Crude PR
Variables								p-value^*
	n	%		n	%		(95%CI)

Age (years)						0.030
19 to 29	24	6.98	12		50.00	1.24 (1.06 - 1.44)
30 to 39	62	18.02	14		22.58	1.01 (0.91 - 1.13)
40 to 49	88	25.58	17		19.32	0.98 (0.89 - 1.09)
50 to 59	84	24.42	16		19.05	0.98 (0.89 - 1.09)
>60	86	25.00	18		20.93	1
Education level						0.050
No education	7	2.03	1		14.29	0.94 (0.73 -1.20)
Elementary grades 1-4	117	34.01	33		28.21	1.05 (0.92 - 1.19)
Elementary grades 5-8	104	30.23	14		13.46	0.93 (0.82 - 1.05)
High school	79	22.97	21		26.58	1.04 (0.91 - 1.19)
Higher education	37	10.76	8		21.62	1
Marital status						0.093
Has partner	203	59.01	39		19.21	1.00
No partner	141	40.99	38		26.95	1.06 (0.99-1.14)
Family income						0.070
<2 MS	161	46.80	44		27.33	1.12 (1.01 - 1.25)
2-5 MS	146	42.44	28		19.18	1.05 (0.94 - 1.17)
>5 MS	37	10.76	5		13.51	1
HD vintage						0.094
=60 months	128	37.21	35		27.34	1.00 (0.99 - 1.15)
<60 months	216	62.79	42		19.44	1
Kt/V						0.005
=1.2	288	83.72	71		24.65	1.12 (1.03 - 1.22)
<1.2	56	16.28	6		10.71	1
kcal/kg IW						0.002
=35	29	8.43	2		6.90	1
<35	315	91.57	75		23.81	1.15 (1.05 - 1.27)
nPNA (g/kg IW)						>0.001
Adequate (=1 g)	173	50.29	26		15.03	1
Inadequate (<1 g)	171	49.71	51		29.82	1.12 (1.05 - 1.21)

Variables	Adjusted PR	95%CI	p-value^*

Age (years)
19 to 29	1.23	1.06-1.43	0.006
30 to 39	1.00	0.90-1.12	0.929
40 to 49	0.98	0.89-1.08	0.713
50 to 59	0.96	0.87-1.07	0.485
>60	1	-	-
Family income
<2 MS	1.13	1.01-1.27	0.020
2-5 MS	1.05	0.94-1.17	0.356
>5 MS	1	-	-
HD vintage
<60 months	1
=60 months	1.08	1.01-1.16	0.035
Kt/V
=1.2	1.12	1.03-1.22	0.010
<1.2	1	-	-
kcal/kg IW
=35	1	-
<35	1.22	1.10- 1.34	<0.001
nPNA (g/kg IW)
Adequate (=1 g)	1	-
Inadequate (<1 g)	1.13	1.05-1.21	0.001

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[1] CONTRIBUTORS ATVS FREITAS, IMF VAZ, and SF FERRAZ helped to conceive the study; collect, analyze, and interpret the data; and write the manuscript. MRG PEIXOTO helped to analyze and interpret the results and to write the manuscript. MIVM CAMPOS helped to interpret the data. All authors reviewed the manuscript.