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Body composition, treatment time, and outcome in hemodialysis patients
1Department of Renal Medicine, Gloucestershire Royal Hospital, Gloucester, UK.
Objective:
To review the nutritional status, hemodialysis (HD) treatment times, and outcome in stable HD patients.
Design:
A cross-sectional study with follow-up 12 months later.
Setting:
Five HD units in the Southwest of England, United Kingdom.
Patients:
A random selection of 180 stable HD patients who had been receiving dialysis treatment for at least 6 months.
Measures:
Anthropometric measurements of triceps and biceps skinfold thickness, and mid arm circumference, to calculate indices of nutritional status and body composition.
Results:
(1) Male HD patients had severe reductions in muscle mass compared with the normal population (P < 0.01), with 50% below the 10th percentile of normal; (2) nondiabetic female patients had significant reductions in body fat stores compared with the normal (P < 0.001); (3) reduced HD treatment times (less than 12 hours per week) were associated with significantly reduced values of muscle mass (P < 0.02) in males and significantly reduced body fat stores (P < 0.001) and muscle mass (P < 0.05) in females; (4) reduced treatment times were also associated with the lowest serum albumin (P < 0.001) and creatinine (P < 0.001) levels; and (5) a serum albumin level below 36 g/L was associated with a 2.4-fold higher mortality rate.
Conclusion:
Despite the apparent well-being of the patients, a substantial proportion are malnourished, with reduced body fat in females and reduced muscle mass in males. Those patients who receive shorter treatment times are at the greatest risk of malnutrition and of having a low serum albumin level, which is related to a higher mortality rate.