Factors predicting malnutrition in hemodialysis patients.

Signs of protein-energy malnutrition are common in maintenance hemodialyis (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 37 HD patients treated with thrice weekly sessions for at least two weeks. Global nutritional status was evaluated by the dual-energy X-ray absorptiometry (DEXA) scan. Body weight and several laboratory values, including serum albumin (Salb), serum prealbumin, bicarbonate, cholesterol, serum C-reactive protein (SCRP), and hemoglobin, were recorded. Dose of dialysis was evaluated by urea kinetic modeling. The patients were subdivided into two groups based on body mass index: group I, normal nutritional status (71%) and group II, malnutrition (29%). The clinical factors associated with malnutrition included advanced age and cardio-vascular diseases (CVD), decreased fat mass (FM) measured by DEXA, low Salb and prealbumin, and severe anemia. The Salb level was not only a predictor of nutritional status, but also was independently influenced by age and SCRP, which was more common in malnourished patients than in patients with normal nutritional status. Both low Kt/V and less weekly dialysis time were associated with malnutrition. The FM and lean body mass (LBM) calculated by DEXA correlated with CVD and other markers of malnutrition (Salb, total cholesterol).