Nutritional status in chronic hemodialysis patients

Hitherto, there has been no systematic evaluation of the nutritional status of HD patients in Thailand. 27 patients awaiting renal transplantation, 19 M 8 F, age 47.2 +/- 8.6 y (mean +/- SD), underwent HD at Ramathibodi Hospital. Dietary assessment revealed the average daily intake of men and women to be respectively 1571 +/- 314 and 1379 +/- 403 kcal, 47 +/- 11 and 42 +/- 14 g protein. Anthropometric data showed that mean of BMI, percent ideal body weight (%IBW), percent standard triceps skinfold thickness (%TSF) and percent arm muscle circumference (%std MUAMC) to be 20.5 +/- 2.6 kg/m2, 90 +/- 12, 75 +/- 30 and 100 +/- 13, respectively. However, 37%, 56% and 70% of these patients had BMI, BW and MUAC less than the minimal cut-off levels. These data reflect the importance of energy depletion in these patients. The average serum albumin was 39 +/- 6 g/L while 52% suffered from low albumin levels. TC, LDL-C, HDL-C and TG were 4.34 +/- 1.34, 2.9 +/- 1.06, 0.89 +/- 0.33 and 1.10 +/- 0.67 mmol/L while 15% had high TC, LDL-C and 58% had low HDL-C levels. Only one patient was suffered from hypertriglyceridemia. Whereas inadequate thiamine, riboflavin, ascorbic acid and alpha-tocopherol status were present in 4-30%, toxic levels of serum retinol were seen in almost all patients. Low serum zinc and copper levels were also present. This study disclosed a wide spectrum of nutritional problems usually overlooked in CRF patients undergoing chronic hemodialysis. Whereas zinc supplementation may be needed, vitamin A supplementation in these patients should be discouraged.