THE IMPACT OF MALNUTRITION IN MORBIDITY AND MORTALITY IN STABLE HEMODIALYSIS-PATIENTS

Background. When assessed by single biochemical measurements, malnutri tion in dialysis patients is associated with increased mortality, but there are few data evaluating abnormalities in anthropometry or compos ite nutritional scores and outcome. The aim of our study was to ascert ain the prevalence and severity of malnutrition in 761 stable patients from 20 haemodialysis centres and its influence in morbidity and mort ality after one year of follow-up. Methods. Malnutrition was estimated by scoring four anthropometric indexes; body mass index (BMI), tricep s skinfold thickness (TSF), mid-arm circumference (MAC), and mid-arm m uscle circumference (MAMC); three biochemical measurements; serum albu min, serum transferrin and total lymphocyte count. and clinical examin ation. Mortality and hospitalizations were collected prospectively dur ing the year of follow-up. Results. A moderate/severe degree of malnut rition was presented by 51.6% of male and 46.3% of female patients. TS F was moderate-severely decreased in 41% without differences between m ales and females. MAMC was moderately decreased in 19.8% of males and in 8.1% of females (P<0.001). Multiple logistic regression analysis sh owed that the predictors of malnutrition were: age >65 years (OR = 1.9 6, CI: 1.22-3.14), male sex (OR = 1.95, CI: 1.24-3.07), comorbidity in dex (OR = 1.23, CI: 1.03-1.45), time on dialysis (OR = 1.13, CI: 1.08- 1.18), duration of dialysis (OR = 0.73, CI: 0.63-0.85) and PCR related to ideal body weight (OR = 0.17, CI: 0.06-0.50). After 1 year of foll ow-up, data from 442 patients were available. A total of 68 patients d ied (15.4%) with cardiovascular diseases being the most frequent cause of death (57.3% of the cases). The predictors of mortality were: age (OR = 1.06, CI: 1.03-1.09), cardiovascular disease (OR = 2.13, CI: 1.1 9-3.83), neurological disease (OR = 2.96, CI: 1.41-6.15), nephroangios clerosis (OR = 2.34, CI: 1.10-4.98) and total lymphocyte count (OR = 0 .93, CI: 0.87-0.98). Hospitalization was needed in 44% of patients. Th e comorbidity index, serum albumin and age were the predictive factors of hospitalization. Conclusions. Protein-calorie malnutrition is freq uent in haemodialysis patients. Fat depletion predominated in both sex es. Duration of dialysis and protein catabolic rate related to ideal b ody weight was the only predictor which could be influenced by a nutri tional intervention. Morbidity appeared to be influenced by the comorb idity index and age was the strongest predictor of mortality. The only nutritional measurements predictive of morbidity and mortality were s erum albumin and total lymphocyte count respectively. Therefore, the i nfluence of malnutrition in morbidity and mortality can not be definit ively stated.