Nutritional status of patients receiving maintenance haemodialysis in Bloemfontein, South Africa

Abstract

Background: Identifying malnutrition in patients on maintenance haemodialysis (MHD) may be challenging in resource-limited sub-Saharan African settings, as several protein-energy malnutrition markers need to be interpreted in combination.
Methods: An observational cross-sectional study was conducted in 2017 in central South Africa to assess nutritional status based on anthropometry, biochemistry, and dietary intake (24-hour recall of typical intake of a non-dialysis day). Malnutrition was assessed using the 2008 International Society of Renal Nutrition and Metabolism (ISRNM) criteria.
Results: Amongst 75 participants (70.7% men; median age 50.5 [IQR: 41–59.6] years), malnutrition was identified in 20.0%. Median monthly income per person in the household of R2 375 (IQR: R817–R5 375) indicated low economic status. Based on body mass index (BMI), only 5.4% were underweight (< 18.5 kg/m2), 23.0% overweight (≥ 25.0 kg/m²) and 33.8% obese (> 30.0 kg/m²); 58.1% had high waist circumferences, and 66.2% high waist-to-height ratio (WHtR > 0.5), indicating central obesity. Overall, 18.9% simultaneously had a high BMI (≥ 25 kg/m²) with low arm muscle area (AMA ≤ 15th centile). Moreover, 49.3% had decreased serum albumin levels (< 35.0 g/l); however, C-reactive protein levels were unavailable. Total dietary protein (TDP) intake was estimated low (< 1.0 g/kg) in 32.4% and 50.7% had high carbohydrate intakes (> 60% of total energy).
Conclusions: In this population receiving MHD, with a low economic status and estimated low total dietary protein intake, poor nutritional status was marked by low muscle mass, and was masked by a high BMI and central obesity.

Keywords: body mass index, chronic kidney disease, dietary protein, malnutrition, muscle mass