Malnutrition in long-term haemodialysis survivors

Background. Long survival is now common in patients with end-stage renal di sease owing to improvement in dialysis techniques and kidney transplantatio n. As malnutrition is commonly reported in dialysis patients, we evaluated the nutritional status of patients treated with haemodialysis (HD) for more than 20 years. Methods. Ten patients (59.5 years old; 4F/6M; HD treatment for 304 months; group A) underwent an extensive nutritional examination and were compared t o a control group of 10 patients treated with HD for an average of 51 month s and strictly matched for age (58.6 years old), gender, and height (group B). The patients were treated on a similar basis (long-duration HD, cellulo sic membranes, Daugirdas index >2). Results. The body weight (BW) in group A had decreased gradually from the 1 1th year of HD treatment, whereas it had increased by an average of 1.9+/-4 .4% since the beginning of the HD treatment in group B. The body mass index (BMI) was lower in group A (19.3+/-2.3 vs 21.4+/-2.8 kg/m(2); P = 0.05). T he arm-muscle circumference (AMC), the arm-muscle area (AMA), and triceps s kinfold (TSF) were lower in group A than in group B. The fat mass assessed with anthropometry (10.8+/-4.0 vs 14.8+/-4.2 kg) was significantly lower in group A. The deviation of actual BW from ideal BW (IBW) was significantly lower in group A than in group B (80.6+/-10.7% vs 89.6+/-9.0%; P=0.028); Th e deviations of actual BW, TSF, and AMA from standard values of the NHANES II study were more marked in group A than in group B. On the other hand, da ily energy and protein intakes (DEI and DPI) were identical in both groups and met the recommendations for dialysis patients when normalized to the ac tual BW. When normalized to the IBW, the DEI appeared low. Energy expenditu re was not different between groups, and not different from the resting met abolism calculated from the Harris and Benedict formula. Average albumin, p realbumin, and IgF-1 were normal and not different between groups. Branched -chain amino acids (BCAA), and especially leucine, were correlated with BMI in group A but not in group B. Serum total and free carnitine were low in both groups. Three patients had ascorbic acid deficiency ingroup A but none in group B. Conclusions. Hence, despite adequate dialysis dose and protein intake, pati ents treated with HD for a long period of time became malnourished, whereas the classical nutritional markers remained in normal ranges. Among the pot ential causes leading to malnutrition, inadequate energy intake and micronu trient deficiencies were found in these patients.