IMPACT OF LONG-TERM HEMODIALYSIS ON NUTRITIONAL-STATUS IN PATIENTS WITH END-STAGE RENAL-FAILURE

We evaluated the way in which duration of hemodialysis treatment affec ts nutritional status in 96 end-stage renal failure patients. Accordin g to the length of previous hemodialysis treatment patients were divid ed into the groups: onset hemodialysis (ON-HD), early-stage hemodialys is (ES-HD, 1-8 months), mid-stage hemodialysis (MS-HD, 9-69 months), a nd advanced-stage hemodialysis (AS-HD, 70-207 months). Nutritional sta tus was assessed by laboratory data (serum proteins, total lymphocyte count), intradermal skin antigen testing, anthropometric measurements (body mass index [BMI], infrared interactance), and records of food in take. ON-HD patients on a low-protein diet exhibited abnormally low va lues for serum total protein, albumin, transferrin, and total lymphocy te count and a high prevalence of anergy to skin antigens (69%). In th e ES-HD and MS-HD groups values for serum proteins and total lymphocyt e count were in the normal range and significantly higher than in ON-H D patients. In addition, a lower proportion of cutaneous anergy was ob served (50% and 27%, respectively). Long-term hemodialysis therapy for 6-17 years (AS-HD) was associated with normal levels for all measured serum proteins. Subnormal levels of total lymphocyte count, significa ntly lower than in MS-HD patients, were associated with an increase in anergy to skin antigens (46%). Serum prealbumin, complement C3c, BMI, body fat, and lean body mass exhibited normal values in all patients and showed no differences between groups. These results indicate that diminished visceral protein stores, lymphopenia, and anergy to skin an tigens are widespread in undialyzed uremic patients with end-stage ren al failure but become uncommon after the initiation of regular hemodia lysis therapy. Even patients on long-term hemodialysis for 6-17 years can maintain their serum protein levels, BMI, body fat, and lean body mass in the normal range. The catabolic stimulus of the dialysis proce dure itself does not seem to outweigh its beneficial effect of removin g uremic toxins when patients are treated for so many years. The occur rence of lymphopenia and a higher proportion of anergy to skin antigen s in AS-HD patients indicates that hemodialysis treatment of very long duration has a depressive effect on immunological functions, but not on nutritional status.