Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Malnutrition risk, nutritional knowledge, and dietary intake in chronic kidney disease patients on hemodialysis: comparison according to coexisting diabetes

투석치료 중인 만성콩팥병 환자의 영양불량, 영양지식 및 식사 섭취 실태: 당뇨병 동반여부에 따른 비교

  • HyunJung Yoo (Department of Food Science & Nutrition, The Catholic University of Korea) ;
  • Sang Cheol Lee (Yonsei Keunsoup Clinic) ;
  • Hye-Kyeong Kim (Department of Food Science & Nutrition, The Catholic University of Korea)
  • Received : 2024.08.07
  • Accepted : 2024.10.23
  • Published : 2024.10.31
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Abstract

Purpose: Malnutrition is a prevalent condition leading to a high risk of morbidity and mortality in hemodialysis patients. This study examined the malnutrition risk and the influence of diabetes on clinical characteristics, nutritional knowledge, and dietary intake in chronic kidney disease (CKD) patients on hemodialysis. Methods: Seventy-six patients (37 with diabetes and 39 without diabetes) enrolled in an internal medicine hemodialysis unit in Seoul were examined. A questionnaire, anthropometric, biochemical, and three-day dietary record data were collected. The nutritional risk was screened by the Patient-Generated Subjective Global Assessment (PG-SGA), compared to the Global Leadership Initiative on Malnutrition (GLIM). Results: The overall prevalence of malnutrition was 56.6% and 27.6% by PG-SGA and GLIM, respectively, showing the low sensitivity (34.9%) and agreement (kappa = 0.16) of GLIM compared to the PG-SGA. CKD patients with diabetes had a higher malnutrition risk and more comorbidities than those without diabetes (p < 0.05). More than 60% of patients had anemia and hypocholesterolemia. Despite the fair level of nutritional knowledge, the intakes of energy per ideal body weight, calcium, vitamin A, vitamin B6, folate, and vitamin C were below the nutritional guidelines for hemodialysis patients in more than 70% of the patients. When stratified according to sex, female patients showed marked differences, with lower energy, protein, fat, calcium, phosphorus, vitamin B2, folate, and vitamin B12 intakes in diabetic patients compared to non-diabetic patients. The most challenging aspect of diet therapy for hemodialysis patients was achieving the appropriate protein intake for diabetic patients and restricting phosphorus intake for non-diabetic patients (p < 0.05). Conclusion: These findings suggest that attention should be paid to the malnutrition of diabetic hemodialysis patients. Individualized nutritional counseling and management are needed for the nutritional care of hemodialysis patients to address the nutritional deficiency.

본 연구는 서울 시의 한 내과 인공신장실에서 혈액투석 치료를 받는 만성콩팥병 환자 76명을 대상으로 영양불량 위험도와 당뇨병이 임상적 특성, 영양지식, 식사섭취에 미치는 영향을 연구하였다. 영양불량 판정 결과 PG-SGA에 의한 영양불량은 56.6%, GLIM에 의한 영양불량은 27.6%였고 GLIM은 PG-SGA에 의한 영양불량 판정에 비해 낮은 민감도와 유사성을 나타냈다. 당뇨병을 가진 만성콩팥병 투석 환자는 비당뇨환자에 비해 영양불량 위험도가 높고 동반질환의 수가 많았다. 대상자의 60% 이상에서 빈혈과 저콜레스테롤혈증이 나타났다. 혈액투석 환자의 식사 섭취에 대한 영양지식이 전반적으로 양호함에도 불구하고 대상자의 70% 이상에서 표준체중당 에너지, 칼슘, 비타민 A, 비타민 B6, 엽산, 비타민 C의 섭취량이 투석 환자를 위한 영양권장량 이하로 나타났다. 성별에 따른 분석결과 여성에서 당뇨병 유무에 따른 영양소 섭취가 뚜렷한 차이를 보여 여성 혈액투석 환자는 비당뇨환자에 비해 에너지, 단백질, 지질, 칼슘, 인, 비타민 B2, 엽산, 비타민 B12의 섭취량이 낮았다. 혈액투석 식사요법 지침 중 당뇨군에서는 적절한 양의 단백질 섭취를, 비당뇨군은 인 섭취 제한을 어려워하는 것으로 나타났다. 이러한 연구결과를 토대로 당뇨병을 동반한 혈액투석 환자의 영양불량 위험성에 주목하고 환자의 개별화된 영양상담과 관리를 통해 영양섭취 부족을 해결해야 할 것으로 사료된다.

Keywords

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