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

Introduction: Malnutrition is a common condition among patients receiving hemodialysis and one of the principal indicators of mortality and morbidity. Objectives: The main aim of the study was to assess the nutritional status of hemodialysis recipients. Methods: A cross-sectional study was conducted on fifty-five 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. Results: 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). Conclusion: 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.