Comparison of the Nutritional Status Assessment Methods for Hemodialysis Patients

Protein-energy wasting (PEW) is prevalent among hemodialysis (HD) patients and is associated with poor outcomes. There are various methods for nutritional status evaluation in HD patients. Each method has its own advantages and disadvantages. We aimed at comparing the method validities of normalized protein catabolic ratio (nPCR) and malnutrition universal screening tool (MUST) with subjective global assessment (SGA) in HD patients. We examined 88 HD patients using SGA and MUST questionnaires. The nPCRs were calculated using pre-dialysis and post-dialysis BUN and Kt/v. Also, PEW of patients was assessed based on the criteria of the International Society of Renal Nutrition and Metabolism. Methods' specificity, sensitivity, and precision rates were assessed. Correlations between methods were analyzed using Pearson-correlation. Based on the SGA, MUST, and nPCR methods, almost 41%, 30%, and 60% of patients had malnutrition, respectively. According to the criteria, more than 90% of patients had PEW. SGA was positively and significantly associated with MUST (p ≤ 0.001). Sensitivity for SGA, MUST, and nPCR methods were 100%,100%, 1.8%, and their specificity were 98%, 98%, and 4%, and their precision rates were 99.7%, 98.7%, and 3%, respectively. From various methods of nutritional assessment (SGA, MUST, and nPCR), compared to SGA as the common method of nutrition assessment in hemodialysis patients, MUST had the nearest specificity, sensitivity, and precision rate and nPCR method had the lowest ones. nPCR seems to be a flawed marker of malnutrition and it should be more investigated if MUST can be used instead of SGA.