[Comparison of some nutritional parameters in hemodialysis patients over and below 65 years of age]

There is a close relationship between inflammation, malnutrition and atherosclerosis in chronic hemodialysis (HD) patients (pts). This process is closely related to poor clinical outcomes including morbidity and mortality, especially in elderly patients. The aim of this study conducted in HD pts over 65 years old (group A) and in younger pts (group B) was the assessment of some parameters of: nutritional status, inflammation, atherosclerosis and anthropometry. In group A (40 pts), mean age 72,2 +/- 4,7, the time on HD treatment was 37,1 +/- 33,0 months and in group B (83 pts), mean age 48,3 +/- 9,7 years, time on HD treatment was 97,4 +/- 90,1 months. We have measured the serum concentrations (conc.) of some parameters: hemoglobin (Hb), C-reactive protein total (CRP), albumin (alb), cholesterol (t-chol), calcium (Ca), phoshorus (P), intact parathormone (iPTH). The adequacy of HD was measured by Kt/V. We have estimated: body mass index (BMI), interdialytic weight gain (IWG), normalized protein catabolic rate (nPCR) and weekly EPO consumption. Some anthropometric parameters which were studied included: triceps skin fold (TSF), waist circumference (WC), mid-arm muscle circumference (MC). The physical activity was expressed by hand grip test (GT) on the hand without the vascular access. The mean values of Kt/V were similar in both groups (1,2 +/- 0,1 vs 1,2 +/- 0,2). Likewise there were no significant differences in mean levels of CRP (9,7 +/- 9,1 vs 14,1 +/- 12,2 mg/l) and Hb (6,7 +/- 0,7 vs 7,0 +/- 0,9 mmol/l), but weekly EPO consumption was higher in group A (48,1 +/- 35,8 vs 38,6 +/- 29,3 U/kg, p<0,01). We have observed, that in group A the mean serum levels of albumin and t-chol were significantly lower (33,2 +/- 3,1 vs 37,5 +/- 3,9 g/l, p <0,05 and respectively 3,9 +/- 0,7 vs 4,3 +/- 0,9 mmol/l, p<0,05).) and IWG as well (2,1 +/- 1,2 vs 3,3 +/- 1,6 kg; p<0,01). The mean values BMI and nPCR were significantly lower in group A (24,4 +/- 3,2 vs 27,3 +/- 2,5 kg/m2, p<0,01 and respectively: 0,9 +/- 0,1 vs 1,1 +/- 0,2 g/kg/day, p<0,01). Likewise mean values of IWG and MAP were significantly lower in elderly patients (2,1 +/- 1,2 vs 3,3 +/- 1,6 kg; p<0,01 and respectively 91,5 +/- 19 vs 95,5 +/- 13 mm Hg; p<0,01). Mean serum Ca and P conc. were significantly lower in group A (2,1 +/- 0,1 vs 2,3 +/- 0,2 mmol/l, p<0,01 and respectively 1,4 +/- 0,3 vs 1,8 +/- 0,5 mmol/l, p<0,01). Likewise mean iPTH conc. was significantly lower in elderly patients (379,2 +/- 362,3 vs 571,6 +/- 510,9 pg/ml). The mean values of strength of grip were lower in group A (20,5 +/- 11,4 vs 34,7 +/- 13,6 kg, p<0,01). In both groups there were no significant differences between the mean values of TSF (11,2 +/- 3,8 vs 13,4 +/- 6,8 mm), but mean values of WC and as well MC as well were lower in group A (91,0 +/- 8,1 vs 98 +/- 12,4 cm; p<0,05 and respectively 25,5 +/- 3,1 vs 28,9 +/- 3,8 cm; p<0,05). There was a significant negative correlation (cor.) between the age of patient and intradialytic body weight gain (r = -0,4607, p<0,001) and significant positive cor. between: albumin and nPCR (r = 0,433, p<0,01) and albumin and Hb (r = 0,391, p<0,01). There was a significant negative cor. between strength of grip and time of HD treatment (r = -0,350, p<0,05).

The studied elderly hemodialysis patients are more malnourished than younger ones.