MALNUTRITION IN HEMODIALYSIS-PATIENTS - C LINICAL-ASSESSMENT VERSUS PATIENT SELF-ASSESSMENT

Background: Malnutrition in hemodialysis patients is associated with i ncreased mortality and morbidity. Interventions to treat malnutrition are often ineffective. Underestimation by the patients of the importan ce of dietary interventions might negatively influence any therapeutic outcome. We examined the correlation between nutritional assessment b y the patient himself and clinical assessment by the physician. Patien ts and Methods: Subjective global assessment (SGA) was performed in 68 chronic hemodialysis patients. Serum concentrations of albumin, preal bumin, transferrin and cholesterin were measured. Protein intake was e stimated by protein catabolic rate (nPCR). In form of a questionaire p atients were asked to assess their own nutrition. Results: According t o SGA-criteria, moderate to severe malnutrition was found in 34% of ou r patients. In this malnourished group serum albumin was <4.0 g/dl in 45% of patients and correlated best with clinical nutritional assessme nt. Specificity was lower for prealbumin, transferrin, cholesterin, an d nPCR. The questionaire was completed by 85% of patients. Sell-assess ment of their own nutrition was discrepant to clinical assessment in 8 4% of malnourished patients. A similar percentage (79%) of malnourishe d patients considered their own body weight to be adequate, while only 21% indicated desire to gain weight. Conclusions: Our data indicate t hat a significant percentage of malnourished hemodialysis patients sho ws a tendency to overestimate their own nutrition. This may negatively influence patient compliance and should be considered in dietary coun seling of malnourished chronic hemodialysis patients.