Barril Guillermina, Nogueira Angel, Cigarrán Secundino, La Torre Juan, Sanchez Rosa, de Santos Antonio, Hadad Fernando, Amair Ruth, Romaniouk Igor, Truissar Israel
Hospital Universitario de la Princesa, Burela, Spain.
Hospital Universitario de la Princesa, Burela, Spain.
J Ren Nutr. 2023 Jan;33(1):140-146. doi: 10.1053/j.jrn.2022.03.006. Epub 2022 Mar 31.
The aims of this study are to analyze the prevalence of malnutrition in hemodialysis (HD) patients in Spain, and to assess the association of malnutrition in these patients with sociodemographic characteristics, comorbidity, and parameters related to HD.
A multicenter, retrospective, cross-sectional study in HD patients from centers all over Spain was conducted. Nutritional status of patients was assessed using Malnutrition Inflammation Score (MIS), and was stratified according to MIS values into 5 categories: ≤2, normal nutrition; >2 to ≤5, mild malnutrition or risk of malnutrition; >5 to ≤7, moderate malnutrition; >7 to ≤10, severe malnutrition, and >10, extreme malnutrition.
A total of 52 Spanish HD Units participated in the study enrolling 2,748 patients. Mean age of patients was 68.20 ± 14.24 years, 1,811 (65.9%) were men. Mean time on HD was 55.63 ± 63.25 months. Using an MIS cut-off point of 2 for malnutrition, 89% of patients were malnourished (MIS > 2). However, with a cut-off point of 5, more commonly described in the literature, the percentage of patients with malnutrition was reduced to 51.7%. Using this cut-off, we observed significant differences between patients with malnutrition and normo-nourished patients in biochemical parameters, age, Charlson Index, HD residual renal function, scheme, and vascular access (permanent catheter vs arteriovenous fistula). A multivariate regression analysis showed that age, sex, HD scheme, vascular access, residual renal function, and comorbidity index were predictive factors for malnutrition. We found that a high percentage of HD patients with malnutrition did not receive oral supplementation.
The prevalence of malnutrition in HD patients in Spain, assessed using the MIS scale, was high. Higher malnutrition was associated with the use of catheter versus fistula, and standard HD versus online hemodiafiltration, and with the absence of residual renal function, older age, greater comorbidity, and male sex. Malnourished patients had a low rate of oral supplementation.
本研究旨在分析西班牙血液透析（HD）患者中营养不良的患病率，并评估这些患者的营养不良与社会人口学特征、合并症以及与血液透析相关参数之间的关联。
在西班牙各地的中心对血液透析患者进行了一项多中心、回顾性横断面研究。使用营养不良炎症评分（MIS）评估患者的营养状况，并根据MIS值分为5类：≤2，营养正常；>2至≤5，轻度营养不良或营养不良风险；>5至≤7，中度营养不良；>7至≤10，重度营养不良；>10，极重度营养不良。
共有52个西班牙血液透析单位参与了该研究，纳入2748例患者。患者的平均年龄为68.20±14.24岁，1811例（65.9%）为男性。血液透析的平均时间为55.63±63.25个月。以MIS值2作为营养不良的切点，89%的患者存在营养不良（MIS>2）。然而，采用文献中更常用的切点5时，营养不良患者的比例降至51.7%。采用该切点，我们观察到营养不良患者与营养正常患者在生化参数、年龄、Charlson指数、血液透析残余肾功能、方案和血管通路（永久性导管与动静脉内瘘）方面存在显著差异。多因素回归分析显示，年龄、性别、血液透析方案、血管通路、残余肾功能和合并症指数是营养不良的预测因素。我们发现，高比例的营养不良血液透析患者未接受口服补充剂。
使用MIS量表评估，西班牙血液透析患者中营养不良的患病率较高。较高的营养不良与使用导管而非内瘘、标准血液透析而非联机血液透析滤过、无残余肾功能、年龄较大、合并症较多以及男性性别相关。营养不良患者口服补充剂的使用率较低。
