Nutritional Profile and Inflammatory Status of Hemodialysis Patients

Abstract

Background. Malnutrition and abnormal inflammatory markers are prominent features of the uremic syndrome, but associations and repercussions are somewhat controversial. Objective. To determine nutritional and clinical profile of hemodialysis patients, aiming at potential diagnostic recommendations for stable subjects with elevated C-reactive protein. Material and Method. Design: Prospective observational cross-sectional clinical study in a stable chronic hemodialysis population; Setting: Renal and Nutritional Service of a mid-size charity academic hospital; Patients: Subjects (n = 44) were analyzed concerning nutritional status and C-reactive protein. Some displayed acute infections (Group I, n = 9) and others did not (Group II, n = 35). Age was 47.0 ± 16.9 years with 63.6% males. Body mass index (BMI) was 22.2 ± 3.9 kg/m2, calorie intake was 1262 ± 601 kcal/day (20.7 ± 6.7 kcal/kg/day), and protein ingestion was 74.3 ± 16.6 g protein/day (1.2 g/kg/day); Intervention: No nutritional supplement or artificial modality of alimentation was employed in this series; Main outcome measures: Subjective global assessment and C-reactive protein. Results. Malnutrition estimated by subjective global assessment (SGA) was very common (>90%), despite acceptable BMI and serum albumin. C-reactive protein was moderately elevated in 40.9% and was positively associated with SGA and negatively with plasma proteins. Comorbidities were associated positively with extracellular water and negatively with reactance (bioimpedance). When infected versus non-infected cases were analyzed, 100% of the former displayed high CRP concentrations in contrast with 22.9% of remaining patients. Conclusions. 1) Malnutrition profile was rather unique, with relatively favorable objective findings (body mass index, serum albumin) and more deranged SGA; 2) Bioimpedance analysis suggested that phase angle could be used as an indicator of nutritional status; 3) C-reactive protein was negatively associated with plasma proteins; 4) Infected subjects, although few and displaying moderate clinical troubles, were responsible for most C-reactive protein determinations above 8 mg/L; 5) Investigation of occult infectious foci is advised in these circumstances.

Keywords:

• hemodialysis
• renal failure
• C-reactive protein
• acute infection
• nutritional assessment