Mk. Kuhlmann et al., MALNUTRITION IN HEMODIALYSIS-PATIENTS - C LINICAL-ASSESSMENT VERSUS PATIENT SELF-ASSESSMENT, Medizinische Klinik, 92(1), 1997, pp. 13-17
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.