Nutr Res Pract.  2008 Dec;2(4):301-307. 10.4162/nrp.2008.2.4.301.

Nutritional status and the role of diabetes mellitus in hemodialysis patients

• Cho JH
• Hwang JY
• Lee SE
• Jang SP
• Kim WY

• KMID: 2139207
• DOI: http://doi.org/10.4162/nrp.2008.2.4.301

Abstract

This study was aimed to investigate the nutritional status and the role of diabetes mellitus in hemodialysis (HD) patients. Anthropometric, biochemical, and dietary assessments for HD 110 patients (46 males and 64 females) were conducted. Mean body mass index (BMI) was 22.1 kg/m2 and prevalence of underweight (BMI<18.5 kg/m2) was 12%. The hypoalbuminemia (<3.5 g/dl) was found in 15.5% of the subject, and hypocholesterolemia (<150 mg/dl) in 46.4%. About half (50.9%) patients had anemia (hemoglobin: <11.0 g/dL). High prevalence of hyperphosphatemia (66.4%) and hyperkalemia (43.5%) was also observed. More than 60 percent of subjects were below the recommended intake levels of energy (30-35 kcal/kg IBW) and protein (1.2 g/kg IBW). The proportions of subjects taking less than estimated average requirements for calcium, vitamin B1, vitamin B2, vitamin C, and folate were more than 50%, whereas, about 20% of the subjects were above the recommended intake of phosphorus and potassium. Diabetes mellitus was the main cause of ESRD (45.5%). The diabetic ESRD patients showed higher BMI and less HD adequacy than nondiabetic patients. Diabetic patients also showed lower HDL-cholesterol levels. Diabetic ESRD patients had less energy from fat and a greater percentage of calories from carbohydrates. In conclusion, active nutrition monitoring is needed to improve the nutritional status of HD patients. A follow-up study is needed to document a causal relation between diabetes and its impact on morbidity and mortality in ESRD patients.

Keyword

Hemodialysis; nutritional status; diabetic ESRD patients; hypoalbuminemia; hypocholesterolemia

MeSH Terms

Anemia
Ascorbic Acid
Body Mass Index
Calcium
Carbohydrates
Diabetes Mellitus
Folic Acid
Humans
Hyperkalemia
Hyperphosphatemia
Hypoalbuminemia
Kidney Failure, Chronic
Male
Nutritional Status
Phosphorus
Potassium
Prevalence
Renal Dialysis
Riboflavin
Thiamine
Thinness
Ascorbic Acid
Calcium
Carbohydrates
Folic Acid
Phosphorus
Potassium
Riboflavin
Thiamine

Reference

1. Ahn SJ, Choi EJ. Renal Replacement Therapy in Korea-Insan Memorial Registry 1997. The Korean Journal of Nephrology. 1999. 18:1–15.

2. Aoyagi T, Naka H, Miyaji K, Hayakawa K, Ishikawa H, Hata M. Body mass index for chronic hemodialysis patients: stable hemodialysis and mortality. Int J Urol. 2001. 8:S71–S75.

3. Avram MM, Mittman N, Bonomini L, Chattopadhyay J, Fein P. Markers of survival in dialysis: A seven-year prospective study. Am J Kidney Dis. 1995. 26:209–219.

4. Beto JA, Bansal VK. Medical Nutrition Therapy in Chronic Kidney Failure: Integrating Clinical Practice Guidelines. J Am Diet Assoc. 2004. 104:404–409.

5. Bossola M, Muscaritoli M, Tazza L, Giungi S, Tortorelli A, Rossi Fanelli F, Luciani G. Malnutrition in Hemodialysis Patients: What Therapy? Am J Kidney Dis. 2005. 46:371–386.

6. Caglar K, Hakim RM, Ikizler TA. Approaches to the reversal of malnutrition, inflammation, and atherosclerosis in end-stage renal disease. Nutr Rev. 2002. 60:378–387.

7. Cano NJ, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Fouque D, Laville M, Levelve XM. French study Group for Nutrition in Dialysis (FSG-ND). Malnutrition in hemodialysis diabetic patients: evaluation and prognostic influence. Kidney Int. 2002. 62:593–601.

8. Chun SJ. Assessment of Nutritional Status in Hemodialysis Patients. 2001. Yonsei University Graduate School of Korea;Master's Thesis.

9. Churchill DN, Taylor DW, Cook RJ, Laplante P, Barre P, Cartier P, Fay WP, Goldstein MB, Jindal K, Mandin H. Canadian hemodialysis morbidity study. Am J Kidney Dis. 1992. 19:214–234.

10. Daugirdas JT. Second generation logarithmic estimates of single pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol. 1993. 4:1205–1213.

11. ESRD Registry Committee. Current renal replacement therapy in Korea - Insan Memorial Dialysis Registry. 2006. Republic of Korea: Korean Society of Nephrology.

12. Goldwasser P, Mittman N, Antignani A, Burrell D, Michel MA, Collier J, Avram MM. Predictors of mortality in hemodialysis patients. J Am Soc Nephrol. 1993. 3:1613–1622.

13. Iseki K, Yamazato M, Tozawa M, Takishita S. Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int. 2002. 61:1887–1893.

14. Kalantar-Zadeh K, Kopple JD, Deepak S, Block D, Block G. Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire. J Ren Nutr. 2002. 12:17–31.

15. Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD. Malnutrition inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis. 2003. 42:864–881.

16. Kim JH, Kim SR. Subjective global assessment of nutrition in maintenance hemodialysis patients. The Korean Journal of Nephrology. 2001. 20:270–276.

17. Kim S, Sohn C, Chae DW. Comparison of nutritional status and inflammational markers in DM and nonDM hemodialysis patients. Korean Journal of Community Nutrition. 2005. 10:693–699.

18. Kim SM, Lee YS, Cho DK. Nutritional Assessment of the hemodialysis patients. The Korean Journal of Nutrition. 2000. 33:179–185.

19. Kim SY, Jin DC, Bang BK. Current status of dialytic therapy in Korea. Nephrology (Carlton). 2003. 8:S2–S9.

20. Kim YH, Seo HJ, Kim SR. A study of the nutritional status, nutritional knowledge, and dietary habits of the hemodialysis patients. The Korean Journal of Nutrition. 2001. 34:920–928.

21. Kim YK, Choi KH, Kang SW, Hurk HW, Lee SW, Lee HY, Han DS. Nutritional assessment of chronic dialysis patients. The Korean Journal of Nephrology. 1990. 9:58–66.

22. Kobrin SM. Diabetic nephropathy. Dis Mon. 1998. 44:214–234.

23. Kutner NG, Zhang R. Body mass index as a predictor of continued survival in older chronic dialysis patients. Int Urol Nephrol. 2001. 32:441–448.

24. Leavey SF, Strawderman RL, Jones CA, Port FK, Held PJ. Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis. 1998. 31:997–1006.

25. Mafra D, Farage NE, Azevedo DL, Viana GG, Mattos JP, Velarde LG, Fouque D. Impact of serum albumin and body-mass index on survival in hemodialysis patients. Int Urol Nephrol. 2007. 39:619–624.

26. Marcén R, Teruel JL, de la Cal MA, Gámez C. The impact of malnutrition in morbidity and mortality in stable haemodialysis patients. Nephrol Dial Transplant. 1997. 12:2324–2331.

27. Morais AA, Silva MA, Faintuch J, Vidigal EJ, Costa RA, Lyrio DC, Trindade CR, Pitanga KK. Correlation of nutritional status and food intake in hemodialysis patients. Clinics. 2005. 60:185–192.

28. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease. Am J Kidney Dis. 2003. 41:S1–S92.

29. Oksa H, Ahonen K, Pasternack A, Marnela KM. Malnutrition in hemodialysis patients. Scand J Urol Nephrol. 1991. 25:157–161.

30. Okumura K, Iseki K, Wakugami K, Kimura Y, Muratani H, Ikemiya Y, Fukiyama K. Low serum cholesterol as a risk factor for hemorrhagic stroke in men: A community-based mass screening in Okinawa, Japan. Jpn Circ J. 1999. 63:53–58.

31. Owen WF Jr, Lew NL, Liu Y, Lowrie EG, Lazarus JM. The urea reduction ratio and serum albumin concentrations as predictors of mortality in patients undergoing hemodialysis. N Engl J Med. 1993. 329:1001–1006.

32. Port FK, Ashby VB, Dhingra RK, Roys EC, Wolfe RA. Dialysis dose and body mass index are strongly associated with survival in hemodialysis patients. J Am Soc Nephrol. 2002. 13:1061–1066.

33. Qureshi AR, Alvestrand A, Danielsson A, Divino-Filho JC, Gutierrez A, Lindholm B, Bergström J. Factors predicting malnutrition in hemodialysis patients: A cross-sectional study. Kidney Int. 1998. 53:773–782.

34. Raffaitin C, Lasseur C, Chauveau P, Barthe N, Gin H, Combe C, Rigalleau V. Nutritional status in patients with diabetes and chronic kidney disease: a prospective study. Am J Clin Nutr. 2007. 85:96–101.

35. Rocco MV, Dwyer JT, Larive B, Greene T, Cockram DB, Chumlea WC, Kusek JW, Leung J, Burrowes JD, McLeroy SL, Poole D, Uhlin L. HEMO Study Group. The effect of dialysis dose and membrane flux on nutritional parameters in hemodialysis patients. Results of the HEMO study. Kidney Int. 2004. 65:2321–2324.

36. Sanlier N, Demircioğlu Y. Correlation of Dietary Intakes and Biochemical Determinates of Nutrition in Hemodialysis Patients. Ren Fail. 2007. 29:213–218.

37. Teixeira Nunes F, de Campos G, Xavier de Paula SM, Merhi VA, Portero-McLellan KC, da Motta DG, de Oliveira MR. Dialysis adequacy and nutritional status of hemodialysis patients. Hemodial Int. 2008. 12:45–51.

38. Wakugami K, Iseki K, Kimura Y, Okumura K, Ikemiya Y, Muratani H, Fukiyama K. Relationship between serum cholesterol and the risk of acute myocardial infarction in a screened cohort in Okinawa, Japan. Jpn Circ J. 1998. 62:7–14.