Prevalence of protein-energy malnutrition and its various types in hemodialysis patients in Tehran, 2008

Protein-energy malnutrition (PEM) is common in hemodialysis patients. So far, no comprehensive study has been performed on prevalence of PEM in various areas of Iran, including Tehran with the largest number of hemodialysis patients in the country. Furthermore, according to the available literature, there is no report on prevalence of various types of PEM in hemodialysis patients. Therefore, the present study was designed to investigate prevalence of PEM and its various types in Tehran hemodialysis patients in 2008.

In this cross-sectional study, using systematic sampling, 291 hemodialysis patients were randomly selected from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was determined by subjective global assessment (SGA) and their dietary intakes were assessed using a 4-day dietary recall (2 dialysis and 2 non-dialysis days). At the end of the first dialysis session, patient's heights and weights were recorded. Finally, after a 12- to 14- hour fast, 4 mL of blood were obtained from each patient before dialysis and analyzed for the serum urea, creatinine, albumin and CRP.

The prevalence of mild-to-moderate and severe PEM based on SGA was 60.5% and 1% in Tehran hemodialysis patients, respectively. The distribution of the malnourished hemodialysis patients according to type of PEM was as follows: 20.5%, type I (inadequate energy or protein intake, without inflammation); 65.5%, type IIa (inadequate energy or protein intake, with inflammation); and 14% type IIb (adequate energy and protein intake, with inflammation). The distribution of those hemodialysis patients who did not suffer from PEM was as follows: 3.5%, type Ia normal nutritional status (adequate energy and protein intake, without inflammation); 34% type Ib normal nutritional status (inadequate energy or protein intake, without inflammation); 55.5% type IIa normal nutritional status (inadequate energy or protein intake, with inflammation); and 7% type IIb normal nutritional status (adequate energy and protein intake, with inflammation).

The results of the present study indicate that PEM in Tehran hemodialysis patients is considerably prevalent and type IIa is the most common type. In addition, hemodialysis patients with no PEM based on SGA should also be paid attention to because they may have inadequate intake‎ of energy and/or protein and inflammation.