Nutritional status and the role of diabetes mellitus in hemodialysis patients

  • Cho, Ju-Hyun (Dept. of Nutritional Science and Food Management, Ewha Womans University) ;
  • Hwang, Ji-Yun (Dept. of Nutritional Science and Food Management, Ewha Womans University) ;
  • Lee, Sang-Eun (Dept. of Nutritional Science and Food Management, Ewha Womans University) ;
  • Jang, Sang-Pil (Poog Sung Hemodialysis Clinic Center) ;
  • Kim, Wha-Young (Dept. of Nutritional Science and Food Management, Ewha Womans University)
  • Published : 2008.12.31

Abstract

This study was aimed to investigate the nutritional status and the role of diabetes mellitus in hemodialysis (HD) patients. Anthropometric, biochemical, and dietary assessments for HD 110 patients (46 males and 64 females) were conducted. Mean body mass index (BMI) was $22.1\;kg/m^2$ and prevalence of underweight (BMI<$18.5\;kg/m^2$) was 12%. The hypoalbuminemia (<3.5 g/dl) was found in 15.5% of the subject, and hypocholesterolemia (<150 mg/dl) in 46.4%. About half (50.9%) patients had anemia (hemoglobin: <11.0 g/dL). High prevalence of hyperphosphatemia (66.4%) and hyperkalemia (43.5%) was also observed. More than 60 percent of subjects were below the recommended intake levels of energy (30-35 kcal/kg IBW) and protein (1.2 g/kg IBW). The proportions of subjects taking less than estimated average requirements for calcium, vitamin $B_1$, vitamin $B_2$, vitamin C, and folate were more than 50%, whereas, about 20% of the subjects were above the recommended intake of phosphorus and potassium. Diabetes mellitus was the main cause of ESRD (45.5%). The diabetic ESRD patients showed higher HMI and less HD adequacy than nondiabetic patients. Diabetic patients also showed lower HDL-cholesterol levels. Diabetic ESRD patients had less energy from fat and a greater percentage of calories from carbohydrates. In conclusion, active nutrition monitoring is needed to improve the nutritional status of HD patients. A follow-up study is needed to document a causal relation between diabetes and its impact on morbidity and mortality in ESRD patients.

Keywords

References

  1. Ahn SJ & Choi EJ (1999). Renal Replacement Therapy in Korea- Insan Memorial Registry 1997. The Korean Journal of Nephrology 18:1-15
  2. Aoyagi T, Naka H, Miyaji K, Hayakawa K, Ishikawa H & Hata M (2001). Body mass index for chronic hemodialysis patients: stable hemodialysis and mortality. Int J Urol 8:S71-S75 https://doi.org/10.1046/j.1442-2042.2001.00255.x
  3. Avram MM, Mittman N, Bonomini L, Chattopadhyay J & Fein P (1995). Markers of survival in dialysis: A seven-year prospective study. Am J Kidney Dis 26:209-219 https://doi.org/10.1016/0272-6386(95)90176-0
  4. Beto JA & Bansal VK (2004). Medical Nutrition Therapy in Chronic Kidney Failure: Integrating Clinical Practice Guidelines. J Am Diet Assoc 104:404-409 https://doi.org/10.1016/j.jada.2003.12.028
  5. Bossola M, Muscaritoli M, Tazza L, Giungi S, Tortorelli A, Rossi Fanelli F & Luciani G (2005). Malnutrition in Hemodialysis Patients: What Therapy? Am J Kidney Dis 46:371-386 https://doi.org/10.1053/j.ajkd.2005.05.031
  6. Caglar K, Hakim RM & Ikizler TA (2002). Approaches to the reversal of malnutrition, inflammation, and atherosclerosis in endstage renal disease. Nutr Rev 60:378-387 https://doi.org/10.1301/00296640260385928
  7. Cano NJ, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Fouque D, Laville M & Levelve XM: French study Group for Nutrition in Dialysis (FSG-ND) (2002). Malnutrition in hemodialysis diabetic patients: evaluation and prognostic influence. Kidney Int 62:593-601 https://doi.org/10.1046/j.1523-1755.2002.00457.x
  8. Chun SJ (2001). Assessment of Nutritional Status in Hemodialysis Patients. Master's Thesis. Yonsei University Graduate School of Korea
  9. Churchill DN, Taylor DW, Cook RJ, Laplante P, Barre P, Cartier P, Fay WP, Goldstein MB, Jindal K & Mandin H (1992). Canadian hemodialysis morbidity study. Am J Kidney Dis 19:214-234 https://doi.org/10.1016/S0272-6386(13)80002-9
  10. Daugirdas JT (1993). Second generation logarithmic estimates of single pool variable volume Kt/V: an analysis of error. J Am Nephrol 4:1205-1213
  11. ESRD Registry Committee (2006). Current renal replacement therapy in Korea - Insan Memorial Dialysis Registry. Korean Society of Nephrology. Republic of Korea
  12. Goldwasser P, Mittman N, Antignani A, Burrell D, Michel MA, Collier J & Avram MM (1993). Predictors of mortality in hemodialysis patients. J Am Soc Nephrol 3:1613-1622
  13. Iseki K, Yamazato M, Tozawa M & Takishita S (2002). Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int 61:1887-1893 https://doi.org/10.1046/j.1523-1755.2002.00324.x
  14. Kalantar-Zadeh K, Kopple JD, Deepak S, Block D, Block G (2002). Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire. J Ren Nutr 12:17-31 https://doi.org/10.1053/jren.2002.29598
  15. Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM & Kopple JD (2003). Malnutrition inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis 42:864-881 https://doi.org/10.1016/j.ajkd.2003.07.016
  16. Kim JH & Kim SR (2001). Subjective global assessment of nutrition in maintenance hemodialysis patients. The Korean Journal of Nephrology 20:270-276
  17. Kim S, Sohn C & Chae DW (2005). Comparison of nutritional status and inflammational markers in DM and nonDM hemodialysis patients. Korean Journal of Community Nutrition 10:693-699
  18. Kim SM, Lee YS & Cho DK (2000). Nutritional Assessment of the hemodialysis patients. The Korean Journal of Nutrition 33:179-185
  19. Kim SY, Jin DC & Bang BK (2003). Current status of dialytic therapy in Korea. Nephrology (Carlton, Vic.) 8:S2-9 https://doi.org/10.1046/j.1440-1797.8.s.5.x
  20. Kim YH, Seo HJ & Kim SR (2001). A study of the nutritional status, nutritional knowledge, and dietary habits of the hemodialysis patients. The Korean Journal of Nutrition 34:920-928
  21. Kim YK, Choi KH, Kang SW, Hurk HW, Lee SW, Lee HY & Han DS (1990). Nutritional assessment of chronic dialysis patients. The Korean Journal of Nephrology 9:58-66
  22. Kobrin SM (1998). Diabetic nephropathy. Dis Mon 44:214-34 https://doi.org/10.1016/S0011-5029(98)90022-0
  23. Kutner NG & Zhang R (2001). Body mass index as a predictor of continued survival in older chronic dialysis patients. Int Urol Nephrol 32:441-448 https://doi.org/10.1023/A:1017581726362
  24. Leavey SF, Strawderman RL, Jones CA, Port FK & Held PJ (1998). Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis 31:997-1006 https://doi.org/10.1053/ajkd.1998.v31.pm9631845
  25. Mafra D, Farage NE, Azevedo DL, Viana GG, Mattos JP, Velarde LG & Fouque D (2007). Impact of serum albumin and body-mass index on survival in hemodialysis patients. Int Urol Nephrol 39:619-624 https://doi.org/10.1007/s11255-007-9201-2
  26. Marcen R, Teruel JL, de la Cal MA & Gamez C (1997). The impact of malnutrition in morbidity and mortality in stable haemodialysis patients. Nephrol Dial Transplant 12:2324-2331 https://doi.org/10.1093/ndt/12.11.2324
  27. Morais AA, Silva MA, Faintuch J, Vidigal EJ, Costa RA, Lyrio DC, Trindade CR & Pitanga KK (2005). Correlation of nutritional status and food intake in hemodialysis patients. Clinics 60:185-192 https://doi.org/10.1590/S1807-59322005000300002
  28. National Kidney Foundation (2003). K/DOQI Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease. Am J Kidney Dis 41:S1-S92 https://doi.org/10.1016/S0272-6386(03)70048-1
  29. Oksa H, Ahonen K, Pasternack A & Marnela KM (1991). Malnutrition in hemodialysis patients. Scand J Urol Nephrol 25:157-161 https://doi.org/10.3109/00365599109024551
  30. Okumura K, Iseki K, Wakugami K, Kimura Y, Muratani H, Ikemiya Y & Fukiyama K (1999). Low serum cholesterol as a risk factor for hemorrhagic stroke in men: A community-based mass screening in Okinawa, Japan. Jpn Circ J 63:53-58 https://doi.org/10.1253/jcj.63.53
  31. Owen WF Jr, Lew NL, Liu Y, Lowrie EG & Lazarus JM (1993). The urea reduction ratio and serum albumin concentrations as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 329:1001-1006 https://doi.org/10.1056/NEJM199309303291404
  32. Port FK, Ashby VB, Dhingra RK, Roys EC & Wolfe RA (2002). Dialysis dose and body mass index are strongly associated with survival in hemodialysis patients. J Am Soc Nephrol 13:1061-1066
  33. Qureshi AR, Alvestrand A, Danielsson A, Divino-Filho JC, Gutierrez A, Lindholm B & Bergström J (1998). Factors predicting malnutrition in hemodialysis patients: A cross-sectional study. Kidney Int 53: 773-782 https://doi.org/10.1046/j.1523-1755.1998.00812.x
  34. Raffaitin C, Lasseur C, Chauveau P, Barthe N, Gin H, Combe C & Rigalleau V (2007). Nutritional status in patients with diabetes and chronic kidney disease: a prospective study. Am J Clin Nutr 85:96-101 https://doi.org/10.1093/ajcn/85.1.96
  35. Rocco MV, Dwyer JT, Larive B, Greene T, Cockram DB, Chumlea WC, Kusek JW, Leung J, Burrowes JD, McLeroy SL, Poole D & Uhlin L; HEMO Study Group (2004). The effect of dialysis dose and membrane flux on nutritional parameters in hemodialysis patients. Results of the HEMO study. Kidney Int 65:2321-2324 https://doi.org/10.1111/j.1523-1755.2004.00647.x
  36. Sanlier N & Demircioğlu Y (2007). Correlation of Dietary Intakes and Biochemical Determinates of Nutrition in Hemodialysis Patients. Ren Fail 29:213-218 https://doi.org/10.1080/08860220601098904
  37. Teixeira Nunes F, de Campos G, Xavier de Paula SM, Merhi VA, Portero-McLellan KC, da Motta DG & de Oliveira MR (2008). Dialysis adequacy and nutritional status of hemodialysis patients. Hemodial Int 12:45-51 https://doi.org/10.1111/j.1542-4758.2008.00239.x
  38. Wakugami K, Iseki K, Kimura Y, Okumura K, Ikemiya Y, Muratani H & Fukiyama K (1998). Relationship between serum cholesterol and the risk of acute myocardial infarction in a screened cohort in Okinawa, Japan. Jpn Circ J 62:7-14 https://doi.org/10.1253/jcj.62.7