Prevalence of Protein-energy Wasting and Its Various Types in Iranian Hemodialysis Patients: A New Classification

Abstract

Background: This study was designed to determine the prevalence of protein-energy wasting (PEW) and its various types in hemodialysis (HD) patients in Tehran, Iran. Methods: For this cross-sectional study, 291 HD patients were randomly selected. The nutritional status of the patients was determined by subjective global assessment (SGA) and their dietary intakes were assessed using a 4-day dietary recall. In addition, serum high-sensitive C-reactive protein (hs-CRP) was measured. Results: The prevalence of mild-to-moderate and severe PEW based on SGA was 60.5% and 1% in Tehran HD patients, respectively. The prevalence of various types of PEW in HD patients was 20.5% type I (inadequate energy or protein intake without inflammation), 65.5% type IIa (inadequate energy or protein intake with inflammation), and 14% type IIb (adequate energy and protein intake with inflammation). Of the total HD patients with no PEW based on SGA, about 3.5% had type 0 normal nutritional status (adequate energy and protein intake without inflammation), 34% had type I normal nutritional status (inadequate energy or protein intake without inflammation), 55.5% had type IIa normal nutritional status (inadequate energy or protein intake with inflammation), and 7% had type IIb normal nutritional status (adequate energy and protein intake with inflammation). Conclusion: PEW in Tehran HD patients is considerably prevalent and PEW type IIa is the most common type. In addition, HD patients with no PEW based on SGA should also be paid attention because they may be in the early stages of inadequate intake of energy and/or protein and inflammation.

• protein-energy wasting
• subjective global assessment
• inflammation
• hemodialysis
• Iran

ACKNOWLEDGMENTS

This study was supported by the National Nutrition and Food Technology Research Institute of Iran.

The authors thank the staff of the Tehran HD centers for their invaluable assistance and the staff of the research laboratory of Research Institute for Endocrine Sciences for their technical assistance. We would also like to acknowledge Ms. Nilufar Shiva for the language editing of the article.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.