Evaluation of the Nutritional Status of Chronic Haemodialysis Patients at Nouakchott National Hospital (Mauritania): Prevalence and Risk Factors for Undernutrition

Introduction: Protein-Energy Undernutrition (PEU) is common in chronic haemodialysis patients and is an important contributor to morbidity and mortality. However, limited data are available on the prevalence of PEU in the dialysis population of Africa. The objectives of this study were to evaluate the nutritional profile of chronic haemodialysis patients in Nouakchott (Mauritania) to determine the prevalence of undernutrition in this population and to identify predictive factors. Patients and methods: This descriptive, analytical, cross-sectional study was conducted from 12 January to 8 September 2015, and involved patients on haemodialysis who regularly attended the haemodialysis unit (at least 3 months) of the Nouakchott Hospital Center. The Subjective Global Assessment (SGA) according to Detsky was used to assess the nutritional status of patients. We also collected epidemiological, dialytical, clinical and anthropometric data. Results: Sixty-nine chronic haemodialysis patients were included. The mean age was 45.9 ± 14.08 years, and the sex ratio was 0.97. The mean duration of haemodialysis was 27 months and 20 days. Anorexia was found in 59.4% of cases, and the mean Body Mass Index (BMI) was 24.38 ± 3.74 kg/m2. The average Branchial Circumference (CB) was 22.91 ± 3.6 cm. Patients showed mean albumin and haemoglobin levels of 38.69 g/L (range 19.2-48.4 g/L) and 8.3 ± 0.9 g/dL, respectively, and biological inflammatory syndrome was found in 16.17% of patients. The prevalence of malnutrition was 36.2%, which was classified as moderate in 20.3% of cases and severe in 15.9% of cases. Malnutrition was found to be correlated with a low socioeconomic status, anorexia, poor dental status, low BMI, hypophosphatemia, hypocholesterolemia, high C-reactive protein CRP and hypoprotidaemia. Conclusion: The prevention of undernutrition through dietary interventions must be at the heart of management for chronic haemodialysis patients. Citation: Lemrabott AT, Faye M, Mah SM, Lemrabott M, Kane Y, et al. Evaluation of the Nutritional Status of Chronic Haemodialysis Patients at Nouakchott National Hospital (Mauritania): Prevalence and Risk Factors for Undernutrition. J Urol Nephrol. 2019;6(2): 5. J Urol Nephrol 6(2): 5 (2019) Page 02 ISSN: 2380-0585 a non-elastic tape measure. The Brachial Circumference (BC) was measured midway between the acromion and the olecranon on the opposite arm to the fistula. The Calf Circumference (CC) of the left leg was measured at the maximum perimeter while the leg was bent at a 90° angle. The Subjective Global Assessment (SGA) according to Detsky was used to assess the nutritional status of patients [6]. This measure was used because the estimates were found to be very close to reality in our chronic haemodialysis patients. The elements taken into account in this study were as follows: change in weight over the past 6 months (weight loss <5%, 6-10%, >10%) and change over the past 2 weeks; changes in dietary intake (no change, marked decrease, inability to eat); gastrointestinal disorders (anorexia, nausea, vomiting, diarrhea, etc.); degree of functional ability (from normal to bed rest); level of metabolic stress (absent, moderate, intense); loss of subcutaneous adipose tissue by the subjective clinical assessment of skin folds (quadricipital, tricipital, pre-thoracic); muscle wasting (quadriceps, deltoids); and the presence or absence of oedema of the ankles and/or as cites. At the end of this evaluation, patients were grouped into three classes (class A, B or C) based on their nutritional status. Patients were classified as class A if they presented a normal nutritional status (absence or low presence of signs), with no physical signs of undernutrition, significant weight loss (weight loss of 5-10% with tendency to weight gain), food problems, functional discomfort or gastrointestinal symptoms that may lead to undernutrition. Class C indicated severe undernutrition (strong presence of signs), where the patient presented physical signs of undernutrition (significant loss of subcutaneous adipose tissue, significant muscle atrophy or oedema) associated with continuous weight loss of at least 10% or a decrease in food intake. Patients were classified as class B, indicating moderate undernutrition (intermediate state), if they presented weight loss of 5-10% without a tendency toward weight gain, associated with the slight loss of muscle or subcutaneous adipose tissue and a reduction in food intake. Indeed, class B is the most ambiguous, and patients in this class could also present characteristics of the other categories. As a general rule, if classifications C and A were not clear, the patient was classified as category B. The biological markers used were albumin, CRP, protidaemia, total cholesterolaemia, urea, creatinine, phosphataemia, haemoglobin and blood ionogram. For statistical analysis, the collected data were captured and analysed with SPSS statistics software (version 20.0). The qualitative variables are presented as percentages and the quantitative variables are presented as the average and standard deviation or with the minimum and maximum values. The statistical analyses were performed with cross-tabulations. To compare the frequencies, the chi-square test, Fisher test or Student’s t-test were used. The difference was statistically significant atp <0.05. The local ethics committee approved the study.