Nutritional Status And Oxidative Stress Of Hemodialysis Patients

Background:Many research revealed that malnutrition was rather prevalent among maintainance hemodialysis patients and was strongly correlated with morbidity and survival rate.The nutritional assessment tools,however,varies among studies and there's no single tool can describe the nutritional stutus.Anthropometry measures and handgrip strength for hemodialysis patients have not been used in China.Nutritional stutus for aged patients was poorer because of their reduced food intake as well as complications.In addition,the oxidative stress among maintenance hemodialysis patients and its relationship with nutritional stutus have not been revealed.Objectives:1.To reveal the nutritional status among the maintainance hemodialysis patients2.To investigate the relationship of different nutritional assessment tools.3.To analyze possible nutrition-related factors.4.To explore the possible relationship between oxidative stress and nutritional status.Methods:PartⅠ:A total of 108 patients receiving hemodialysis were drawn from PUMCHospital for the cross-sectional study from July to September 2008. 1.Subjective global assessment was adopted to evaluate patients'global nutritional status including weight changes,gastrointestinal symptoms,edema,thickness of fat and muscle,etc.2.Handgrip strength (HS) measuremnt of the non-fistula arm, leg circumference(LC),midarm circumference, skinfold thickness of triceps, midarm muscle circumference and body mass index were also measured or calculated.3. Creatinine,urea nitrogen,albumin,pre-albumin and Hypersensitive C-reactive Protein PartⅡ:Measurement of oxidative stress parameters:Maleic Dialdehyde and Super Oxide Dismutase were measured through Thibabituric Acid method and xanthine oxidase method, Mn-SOD was determined by Total SOD minus CuZn-SOD. Controll group were 30 healthy subjects. Results:1. The malnutrition rate of hemodialysis patients was 32.4% based on Subjective Global Assessment, while according to BMI the underweight rate was 12.0%. Aged people presented with higher malnutrition rates(44.1%),higher than that of the middle aged and young patients(27.0%)。Prealbumin,creatinine,handgrip strength and leg circumference among the two groups also showed statistical differences.2. A statistically significant positive relationship was identified between handgrip strength and SGA (r=0.31, P=0.007)。Well nutritioned patients and malnutritional patients differed in handgrip strength (t=3.46, P=0.001).Leg circumference correlated well with other anthropometric parameters and patients with different nutritional status presented with different leg circumference.Albumin did not correlate well with SGA score but correlated well with C-reactive protein (r=-0.36, P=0.001)3.Patients participating in food preparation presented with better nutritional stutas according to SGA(X2=5.90, P=0.015). Patients with diabetes showed higher malnutrition rate (58.8%) than those without it (27.5%, X2=6.43, P=0.011).Patients with different nutritional status presented with different levels of C-reactive protein (t=3.99, P=0.048) and patients with higher level of C-reactive protein presented with different pre-albumin(t=2.30, P=0.001) and handgrip levels(t=2.56, P=0.01).Energy intake and protein intake had impact on patients'anthopometric parameters but little effect on blood nutritional markers.4. The levels of MDA,T-SOD and CuZn-SOD among patients were lower than those of healthy people and correlated well with each other.Logistic regression analysis showed that diabetes,prealbumin,T-SOD and MDA were statistically significant factors influencing the result of subjective global assessment..Conclusions:1.32.4%of patients investigated were malnourished but the malnutrition rate was still lower than those concluded in other research. Aged patients presented with poorer nutritional status and need more attention for care.2. Logistic regression showed that diatetes, participation in food preparation,, handgrip strength,inflammation prealbumin were statistically significantvariables affecting patient's nutritional status.3. Handgrip strength and leg circumference correlated with many nutritional parameters and were plausible due to their convenience and accuracy compared with albumin levels.4. The oxidative stress in hemodialysis patients was abnormal and showed relationship with nutritional parameters.