PMID- 9507226
OWN - NLM
STAT- MEDLINE
DCOM- 19980421
LR  - 20220318
IS  - 0085-2538 (Print)
IS  - 0085-2538 (Linking)
VI  - 53
IP  - 3
DP  - 1998 Mar
TI  - Factors predicting malnutrition in hemodialysis patients: a cross-sectional 
      study.
PG  - 773-82
AB  - Signs of protein-energy malnutrition are common in maintenance hemodialysis (HD) 
      patients and are associated with increased morbidity and mortality. To evaluate 
      the nutritional status and relationship between various parameters used for 
      assessing malnutrition, we performed a cross-sectional study in 128 unselected 
      patients treated with hemodialysis (HD) thrice weekly for at least two weeks. 
      Global nutritional status was evaluated by the subjective global nutritional 
      assessment (SGNA). Body weight, skinfold thicknesses converted into % body fat 
      mass (BFM), mid-arm muscle circumference, hand-grip strength and several 
      laboratory values, including serum albumin (SA1b), plasma insulin-like growth 
      factor I (p-IGF-I), serum C-reactive protein (SCRP) and plasma free amino acids, 
      were recorded. Dose of dialysis and protein equivalence of nitrogen appearance 
      (nPNA) were evaluated by urea kinetic modeling. The patients were subdivided into 
      three groups based on SGNA: group I, normal nutritional status (36%); group II, 
      mild malnutrition (51%); and group III, moderate or (in 2 cases) severe 
      malnutrition (13%). Clinical factors associated with malnutrition were: high age, 
      presence of cardiovascular disease and diabetes mellitus. nPNA and Kt/V(urea) 
      were similar in the three groups. However, when normalized to desirable body wt, 
      both were lower in groups II and III than in group I. Anthropometric factors 
      associated with malnutrition were low body wt, skinfold thickness, mid-arm muscle 
      circumference (MAMC), and handgrip strength. Biochemical factors associated with 
      malnutrition were low serum levels of albumin and creatinine and low plasma 
      levels of insulin-like growth factor 1 (IGF-1) and branched-chain amino acids 
      (isoleucine, leucine and valine). The serum albumin (SAlb) level was not only a 
      predictor of nutritional status, but was independently influenced by age, sex and 
      SCRP. Plasma IGF-1 levels also reflected the presence and severity of 
      malnutrition and appeared to be more closely associated than SAlb with 
      anthropometric and biochemical indices of somatic protein mass. Elevated SCRP (> 
      20 mg/liter), which mainly reflected the presence of infection/inflammation and 
      was associated with hypoalbuminemia, was more common in malnourished patients 
      than in patients with normal nutritional status, and also more common in elderly 
      than in younger patients. Plasma amino acid levels, with the possible exception 
      of the branched-chain amino acids (isoleucine, leucine, valine), seem to be poor 
      predictors of nutritional status in hemodialysis patients.
FAU - Qureshi, A R
AU  - Qureshi AR
AD  - Division of Renal Medicine, Karolinska Institute, Huddinge University Hospital, 
      Stockholm, Sweden.
FAU - Alvestrand, A
AU  - Alvestrand A
FAU - Danielsson, A
AU  - Danielsson A
FAU - Divino-Filho, J C
AU  - Divino-Filho JC
FAU - Gutierrez, A
AU  - Gutierrez A
FAU - Lindholm, B
AU  - Lindholm B
FAU - Bergstrom, J
AU  - Bergstrom J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Kidney Int
JT  - Kidney international
JID - 0323470
RN  - 0 (Serum Albumin)
RN  - 67763-96-6 (Insulin-Like Growth Factor I)
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
CIN - Kidney Int. 1998 Sep;54(3):999. PMID: 9734631
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Anthropometry
MH  - C-Reactive Protein/metabolism
MH  - Cardiovascular Diseases/complications
MH  - Cross-Sectional Studies
MH  - Female
MH  - Humans
MH  - Insulin-Like Growth Factor I/metabolism
MH  - Kidney Failure, Chronic/complications/physiopathology/therapy
MH  - Male
MH  - Middle Aged
MH  - Nutrition Assessment
MH  - Nutritional Status
MH  - Protein-Energy Malnutrition/epidemiology/*etiology/physiopathology
MH  - Renal Dialysis/*adverse effects
MH  - Risk Factors
MH  - Serum Albumin/metabolism
MH  - Sex Factors
MH  - Sweden/epidemiology
EDAT- 1998/03/21 00:00
MHDA- 1998/03/21 00:01
CRDT- 1998/03/21 00:00
PHST- 1998/03/21 00:00 [pubmed]
PHST- 1998/03/21 00:01 [medline]
PHST- 1998/03/21 00:00 [entrez]
AID - S0085-2538(15)60456-2 [pii]
AID - 10.1046/j.1523-1755.1998.00812.x [doi]
PST - ppublish
SO  - Kidney Int. 1998 Mar;53(3):773-82. doi: 10.1046/j.1523-1755.1998.00812.x.