Nutritional assessment of hemodialysis patients aged over 65 years:outcome of a cross-sectional survey conducted in the well-equipped hemodialysis center of the cahors hospital

Abstract

Elderly hemodialysis patients particularly suffer from protein-energy wasting syndrome due to age-related physiological changes. We carried out an observational study from 1 to 30 April 2016 involving 31 elderly hemodialysis patients in the center of Cahors University Hospital. We intended to check how close the 3 methods of nutritional evaluation were, namely ingesta, albumin/prealbumin association and Subjective Global Assessment. We trialed the nutritional status of each patient using the above methods. The mean age was 77.7 ± 7.07 years with M/F ratio of 0.63. Exposure to dialysis was 40.61 ± 67.88 months on average. The mean BMI was 26.67 ± 9.17 kg/m2. The average daily calorie and protein intake was 1297.61 ± 321.73 Kcal and 52.87 ± 9.89 g, respectively. The average branchial perimeter was 27.53 ± 2.47 cm with a mean triceps skinfold of 9 ± 0.7. The daily protein intake assessed by the nPCR was 0.95 ± 0.21 g/kg/day. The mean albumin and pre-albumin levels were 37.32 ± 1.41 g/l and 283.22 ± 35.35 mg/l. The average Kt/V was 1.98 ± 0.35. According to the SGA, 26 (83.87%) were in good nutritional status (subgroup 1), 3 (9.67%) were suffering from mild undernutrition (subgroup 2) and 2 (6.46%) had acute undernutrition (subgroup 3). Relying on albumin and pre- albumin levels, 18 (58.06%) were in good nutritional status, 6 (19.36%) had mild undernutrition and 7 (22.58%) acute undernutrition. According to the ingesta, 2 (6.46%) patients were in subgroup 1, 8 (25.81%) patients in subgroup 2 and 21 (67.74%) in subgroup 3. No agreement was found between the 3 evaluators of nutritional status (kappa to assess SGA and albumin-pre-albumin association at -0.075 [95% confidence interval: -0.175 to 0.024]; kappa as a measurement for SGA and ingesta at 0.073 [95 % range: -0.007 to 0.153], kappa for albumin-pre- albumin combination and ingesta at 0.034 [95% confidence interval: -0.058 to 0.126]). Disjunction between the three nutritional evaluators used in our study, in addition to inherent bias in the low number of staff, provides information on the nutritional problems of elderly hemodialysis patients, especially underestimation of nutritional surveys in relation to actual energy intake, nutritional impact of the physiological and socio-economic changes that accompany aging and the lack of nutritional methods and standards specific to this category of population.