Nutritional status of chronic kidney disease patients undergoing hemodialysis in Colombo, Sri Lanka

Malnutrition is a common condition among patients receiving hemodialysis and one of the principal indicators of mortality and morbidity.

The main aim of the study was to assess the nutritional status of hemodialysis recipients.

A cross-sectional study was conducted on fiftyfive patients in two nephrology clinics in Colombo. Data were collected under four categories; an interviewer administered questionnaire, anthropometric measurements, biochemical investigations and derived calculations. Urea reduction ratio and Kt/V were calculated to assess the dialysis efficiency. Nutritional Risk Index was employed to evaluate the malnutrition risk.

In the study population, 70.9% were males and mean age, mean dialysis duration were recorded as 56.05±13.16 years and 13±12 months respectively. According to BMI, 10.9% of the patients were underweight, 38.2%; normal, 14.5%; overweight and 36.4% were obese. Low levels of serum albumin, total protein, iron and hemoglobin were reported among 30.9%, 14.5%, 41.8% and 89.1% of patients respectively. More than 50% of the population had an increased CRP level, depicting an inflammatory reaction. Mean URR and Kt/V of the population were 65.8±9.6% and 1.3±0.3 respectively, which were above the recommended level. Malnutrition risk was negatively correlated with serum total calcium level (r=-0.49, p<0.001), total protein level (r=-0.415, p<0.05), dialysis duration (r=-0.351, p<0.05), diastolic blood pressure (r=-0.35, p<0.05) and MUAC (r=-0.332, p<0.05) and positively correlated with absolute lymphocyte count (r=0.332, p<0.05).

Majority of the patients had an efficient dialysis session. High, moderate and low risk of malnutrition were analyzed as 7.3%, 29.1% and 63.6%. In a binomial logistic regression, total calcium level (p<0.001, Exp(B); 0.027) and appetite of patients (p=0.04, Exp(B);13.816) were identified as strong predictors of malnutrition risk.