[Malnutrition in hemodialysis patients. Self-assessment, medical evaluation and "verifiable" parameters]

Malnutrition in hemodialysis patient is associated with increased mortality and morbidity. Inventions to treat malnutrition are often ineffective. Underestimation by the patients of the importance of dietary interventions might negatively influence any therapeutic outcome. We examined the correlation between nutritional assessment by the patient himself and clinical assessment by the physician.

Subjective global assessment (SGA) was performed in 68 chronic hemodialysis patients Serum concentrations of albumin, prealbumin, transferrin and cholesterin were measured Protein intake was estimated by protein catabolic rate (nPCR). In form of a questionnaire patients were asked to assess then own nutrition.

According to SGA-criteria, moderate to severe malnutrition was found in 34% of our patients. In this unauthorized group serum albumin was < 4.0 g/dl in 45% of patients and correlated best with clinical nutritional assessment. Specificity was lower for prealbumin, transferrin, cholesterin, and nPCR. The questionnaire was completed by 85% of patients. Self-assessment of their own nutrition was discrepant to clinical assessment in 84% of malnourished patients. A similar percentage (79%) of malnourished patients considered their own body weight to be adequate, while only 21% indicated desire to gain weight.

Our data indicate that a significant percentage of malnourished hemodialysis patients shows a tendency to overestimate their own nutrition. This may negatively influence patient compliance and should be considered in dietary counseling of malnourished chronic hemodialysis patients.