Mona Boaz1, Odile Azoulay2, Idit F Schwartz3, Doron Schwartz3, Suhair Assady4, Batya Kristal5, Sydney Benshitrit6, Noa Yanai7, Talia Weinstein8. 1. Department of Nutrition Sciences, Ariel University, Holon, Israel. 2. Department of Nephrology, Rabin Medical Center, Petach Tikva, Israel. 3. Department of Nephrology, Tel Aviv Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel. 4. Department of Nephrology and Hypertension, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. 5. Department of Nephrology, Western Galilee Hospital, Bar Ilan University Medical School, Nahariya, Israel. 6. Department of Nephrology, Meir Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel. 7. Department of Nephrology, Hillel Yaffe Hospital, Tel Aviv, Israel. 8. Department of Nephrology, Tel Aviv Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, tweinste@post.tau.ac.il.
Abstract
BACKGROUND: Malnutrition is a frequently observed disorder in patients with chronic kidney disease (CKD) receiving hemodialysis (HD). While variously defined, malnutrition is a frequently observed condition among patients on HD. Prevalence estimates of malnutrition among Israeli HD patients have not been reported. OBJECTIVES: To survey nutrition intake in Israeli HD patients; estimate malnutrition risk prevalence; identify risk factors, and characterize malnutrition risk in HD patients. METHODS: A representative sample of 378 Israeli HD patients treated in hospital HD centers throughout the country were surveyed. Using the 24-h recall method, dietary intake was estimated and the chronologically corresponding biochemistry, anthropometric, and hemodynamic measures were recorded. Four categories of malnutrition risk were defined: "minimal": body mass index (BMI) > 23 kg/m2 and serum albumin > 3.8 g/dL; "mild": BMI < 23 kg/m2 and albumin > 3.8 g/dL; "moderate": BMI > 23 kg/m2 and albumin < 3.8 g/dL; "severe": BMI < 23 k/m2 and serum albumin < 3.8 g/dL. RESULTS: Elevated malnutrition risk was identified in 175 (46.3%) study participants, who were more likely to require feeding assistance, have major comorbidities, reduced hemoglobin, and elevated C-reactive protein. Oral nutrition supplementation was prescribed to only 14.3% of patients with elevated malnutrition risk. Intradialytic parenteral nutrition was recorded for 6 patients, all of whom had moderate or severe malnutrition risk. Less than one-third of patients met the guidelines for dietary intake of energy or protein, and this did not differ across malnutrition risk groups. DISCUSSION: Elevated malnutrition risk is a frequent finding in HD patients treated in hospital settings in Israel. Dietary intake does not meet guidelines but does not differ across malnutrition risk categories. Nutrition supplements are underused in HD patients with high malnutrition risk. There is a need to expand the survey to community HD centers.
BACKGROUND: Malnutrition is a frequently observed disorder in patients with chronic kidney disease (CKD) receiving hemodialysis (HD). While variously defined, malnutrition is a frequently observed condition among patients on HD. Prevalence estimates of malnutrition among Israeli HDpatients have not been reported. OBJECTIVES: To survey nutrition intake in Israeli HDpatients; estimate malnutrition risk prevalence; identify risk factors, and characterize malnutrition risk in HDpatients. METHODS: A representative sample of 378 Israeli HDpatients treated in hospital HD centers throughout the country were surveyed. Using the 24-h recall method, dietary intake was estimated and the chronologically corresponding biochemistry, anthropometric, and hemodynamic measures were recorded. Four categories of malnutrition risk were defined: "minimal": body mass index (BMI) > 23 kg/m2 and serum albumin > 3.8 g/dL; "mild": BMI < 23 kg/m2 and albumin > 3.8 g/dL; "moderate": BMI > 23 kg/m2 and albumin < 3.8 g/dL; "severe": BMI < 23 k/m2 and serum albumin < 3.8 g/dL. RESULTS:Elevated malnutrition risk was identified in 175 (46.3%) study participants, who were more likely to require feeding assistance, have major comorbidities, reduced hemoglobin, and elevated C-reactive protein. Oral nutrition supplementation was prescribed to only 14.3% of patients with elevated malnutrition risk. Intradialytic parenteral nutrition was recorded for 6 patients, all of whom had moderate or severe malnutrition risk. Less than one-third of patients met the guidelines for dietary intake of energy or protein, and this did not differ across malnutrition risk groups. DISCUSSION: Elevated malnutrition risk is a frequent finding in HDpatients treated in hospital settings in Israel. Dietary intake does not meet guidelines but does not differ across malnutrition risk categories. Nutrition supplements are underused in HDpatients with high malnutrition risk. There is a need to expand the survey to community HD centers.