Correlation between nutritional markers and appetite self-assessments in hemodialysis patients.

OBJECTIVE: Protein-energy malnutrition is among the comorbidities that most strongly affect the prognosis of patients with chronic kidney disease. Anorexia, defined as a loss of desire to eat, is one cause of such malnutrition. Tools that evaluate appetite and the correlation between appetite and nutritional parameters require further study. To evaluate the appetite status in patients from 2 hemodialysis clinics in Fortaleza, Brazil and the correlations between appetite (evaluated in the past week and in the past 4 weeks) and demographic, laboratory, and nutritional parameters. METHODS: This was a cross-sectional study of patients aged ≥18 years who had undergone dialysis for >3 months. Appetite was evaluated using the first 3 questions of the Appetite and Diet Assessment Tool (ADAT) questionnaire, which evaluate the appetite status during the past week as well as 1 question from the Kidney Disease and Quality of Life™ Short Form that assesses appetite in the past 4 weeks. The patients were divided into 3 groups according to the degree of appetite: group 1: very good and good appetite (ADAT) or not and somewhat (Kidney Disease and Quality of Life™ Short Form); group 2: fair or moderately; and group 3: poor and very poor, or very much and extremely. The nutritional parameters evaluated were body mass index (BMI), serum albumin, Geriatric Nutritional Risk Index (GNRI) and lean body mass index (lean mass in kilogram per square meter) as obtained by multifrequency bioelectrical impedance analysis. Patients with a BMI <23 kg/m(2), albumin <4 g/dL, GNRI <98, and lean body mass index below the lowest quartile were considered malnourished. The associations between appetite and nutritional variables were tested using Fisher exact test and by comparing the means of the variables in the 3 groups using the analysis of variance and Kruskal-Wallis tests. RESULTS: A total of 136 patients were included in the study with a mean age of 50.9 years and a median time on dialysis of 45 months; 57% of the patients were male. Regarding the first question on the ADAT questionnaire, 36% of patients exhibited anorexia in the past week. Furthermore, 28.7% of the population reported a lack of appetite in the last month. Moreover, 34.3% of the patients were considered malnourished according to BMI, 34.1% according to albumin, and 31.6% according to GNRI. Among the studied variables, the mean values of the following variables were different between groups 1, 2, and 3: hemoglobin (P = .0186), creatinine (P = .0392), albumin (P = .0065), GNRI (P = .0274), and lean BMI (P = .0274). CONCLUSIONS: The prevalence of a lack of appetite in hemodialysis patients in both the past week and the past month was high in the present study. The questionnaire evaluating appetite in the last 4 weeks could be used as a malnutrition screening tool in hemodialysis patients as suggested by the correlation of decreased appetite in the last month with variables that assess nutritional status such as albumin, lean body mass index, and GNRI.

Depression in dialysis patients and its association with nutritional markers and quality of life.

BACKGROUND: Depression is the most widely prevalent psychiatric disorder in dialysis and can result in a lower quality of life (QoL) and probably a worse nutritional status. The aim of this study was to evaluate the associations among depression, QoL and nutritional status in hemodialysis. METHODS: This study included 104 patients on dialysis longer than 3 months, aged 18-65 years. Their nutritional status was assessed according to body mass index (BMI), serum albumin and phase angle; QoL was assessed using the SF-36 questionnaire, and their risk of depression was measured using the Beck Depression Inventory (BDI). Associations among depression, QoL and nutritional status were assessed using Fisher's exact test, and correlations between continuous variables were examined by Pearson's coefficient. RESULTS: Depression was detected in 65.3% of patients, and all of the dimensions of QoL were compromised, with the worst values observed for role-functioning physical (RP) and general health (GH). A negative correlation between the dimensions of QoL and BDI score was observed. Serum albumin was significantly correlated with general health (GH), and phase angle with physical functioning (PF). CONCLUSION: A high prevalence of depression was detected, as well as reduced mean scores for QoL. BDI score was significantly correlated with both physical and mental components of QoL. Phase angle was associated with physical functioning (PF) and physical component summary scales (PCS), whereas no nutritional marker was associated with the BDI score. The periodic monitoring of depression should be implemented in hemodialysis, in addition to monitoring QoL and nutritional status. A better understanding of these relationships could result in a better efficiency of dialysis treatment.

The phase angle and mass body cell as markers of nutritional status in hemodialysis patients.

OBJECTIVE: Bioelectrical impedance analysis (BIA) is a fast, noninvasive method for assessing body composition, and its role in the evaluation of nutritional status in haemodialysis (HD) has been studied. This study aimed to compare BIA parameters to clinical, biochemical, and anthropometric markers of nutrition in HD patients, such as subjective global assessment modified for renal disease (SGA-1), serum albumin, body mass index (BMI), percent of standard body weight (%SBW), deviation of triceps skinfold thickness (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC) from the standard value (50th percentile), anthropometry-derived fat (FM-A), and fat-free mass (FFM-A). METHODS: BIA was performed 30 minutes after a HD session and the reactance (Xc), resistance (R), phase angle (PA), body cell mass (BCM), fat mass (FM-BIA), and fat-free mass (FFM-BIA) values were recorded. The prevalence of malnutrition was estimated according to PA and percent of BCM. The correlation between methods was assessed through Pearson's correlation coefficient and Bland and Altman analysis. RESULTS: A total of 58 patients were studied (30 women and 28 men; mean age of 49.2 +/- 14.8 years). The mean PA was 6.19 +/- 1.33 degrees and the mean percent of BCM was 33.75 +/- 5.91%. The prevalence of malnutrition was 17.5% and 43.9% according to the PA and percent of BCM, respectively. PA had a negative correlation with age and SGA-1 score and a positive correlation with percent SBW, MAC, MAMC, FFM-A, and albumin. Percent of BCM had a negative correlation with age, MAC, MAMC and FM-A and a positive correlation with FFM-A and albumin. A significant correlation between FFM-A and FFM-BIA was observed, as well as between FM-A and FM-BIA. CONCLUSIONS: BIA indexes reflected nutritional state. PA and BCM seem to be less influenced by changes in volume and can be used for nutritional assessments of dialysis patients.