Protein Energy Wasting in a Cohort of Maintenance Hemodialysis Patients in Dhaka, Bangladesh

• Published in: Nutrients 2022-04, Vol.14 (7), p.1469
• Main Authors: Rahman, Tanjina, Khor, Ban-Hock, Sahathevan, Sharmela, Kaur, Deepinder, Latifi, Eno, Afroz, Mousume, Mitali, Esrat Jahan, Tashkandi, Bayan, Begum, Nura Afza Salma, Kashem, Tasnuva Sarah, Arefin, Shakib Uz Zaman, Daud, Zulfitri Azuan Mat, Karupaiah, Tilakavati, Rashid, Harun Ur, Khosla, Pramod
• Format: Article
• Language: English
• Subjects: Adult; Albumin; Arm; Bangladesh - epidemiology; Bangladeshi hemodialysis patients; Body Composition; C-reactive protein; Cachexia - complications; Cholesterol; Clinical trials; Data collection; Developing countries; Dialysis; Dietitians; dyslipidemia; Energy; Female; Food; Grip strength; Hand Strength; Hemodialysis; High density lipoprotein; Hospitals; Humans; Inflammation; Kidney diseases; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; LDCs; Low density lipoprotein; Male; Malnutrition; Malnutrition - complications; Metabolic disorders; Metabolism; Micronutrients; Middle Aged; Mortality; Muscles; Nutrition assessment; Nutrition research; nutrition status; Nutritional Status; Nutritionists; Patients; protein energy wasting; Protein-Energy Malnutrition - complications; Protein-Energy Malnutrition - etiology; Proteins; Quality of life; Renal Dialysis - adverse effects; Serum albumin; Serum Albumin - metabolism; Software; Triglycerides
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu14071469

Malnutrition is associated with high rates of mortality among patients with end stage kidney disease (ESKD). There is a paucity of data from Bangladesh, where around 35,000−40,000 people reach ESKD annually. We assessed protein-energy wasting (PEW) amongst 133 patients at a single hemodialysis setting in Dhaka. Patients were 49% male, age 50 ± 13 years, 62% were on twice-weekly hemodialysis. Anthropometric, biochemical, and laboratory evaluations revealed: BMI 24.1 ± 5.2 kg/m2, mid-arm muscle circumference (MAMC) 21.6 ± 3.6 cm, and serum albumin 3.7 ± 0.6 g/dL. Based on published criteria, 18% patients had PEW and for these patients, BMI (19.8 ± 2.4 vs. 25.2 ± 5.2 kg/m2), MAMC (19.4 ± 2.4 vs. 22.2 ± 3.8 cm), serum albumin (3.5 ± 0.7 vs. 3.8 ± 0.5 g/dL), and total cholesterol (135 ± 34 vs. 159 ± 40 mg/dL), were significantly lower as compared to non-PEW patients, while hand grip strength was similar (19.5 ± 7.6 vs. 19.7 ± 7.3 kg). Inflammatory C-reactive protein levels tended to be higher in the PEW group (20.0 ± 34.8 vs. 10.0 ± 13.9 p = 0.065). Lipoprotein analyses revealed PEW patients had significantly lower low density lipoprotein cholesterol (71 ± 29 vs. 88 ± 31 mg/dL, p < 0.05) and plasma triglyceride (132 ± 51 vs. 189 ± 103 mg/dL, p < 0.05), while high density lipoprotein cholesterol was similar. Nutritional assessments using a single 24 h recall were possible from 115 of the patients, but only 66 of these were acceptable reporters. Amongst these, while no major differences were noted between PEW and non-PEW patients, the majority of patients did not meet dietary recommendations for energy, protein, fiber, and several micronutrients (in some cases intakes were 60−90% below recommendations). Malnutrition Inflammation Scores were significantly higher in PEW patients (7.6 ± 3.1 vs. 5.3 ± 2.7 p < 0.004). No discernible differences were apparent in measured parameters between patients on twice- vs. thrice-weekly dialysis. Data from a larger cohort are needed prior to establishing patient-management guidelines for PEW in this population.