#2896 Malnutrition is prevalent in hemodialysis patients—results from Croatian multicenter hemodialysis study
Authors: Radić Josipa , Klaric Dragan , Nenadić Dora Bučan , Cvečić Borna , Vujicic Bozidar , Margeta Tea Vrdoljak , Pavić Eva , Durlen Ivan , Crnković Ivana Bedalov , Linc Sonja , Iskra Ivana , Barbić Jerko 
Published: May 2024

Abstract

Background and Aims
Malnutrition is a usually observed condition among patients on hemodialysis (HD) and is considered one of studiest indicators of mortality and morbidity. Malnutrition inflammation score (MIS) is associated with inflammation, nutritional status, quality of life, and 5-year prospective mortality. Also, phase angle (PhA) measured by bioelectrical impedance analysis (BIA) has been studied as indicator of nutritional status or muscle function in HD patients and lower PhA was associated with a greater risk of malnutrition. The aims of this study are to analyze the prevalence of malnutrition in hemodialysis (HD) patients in Croatia using MIS, and to assess the association of MIS and PhA with body mass composition, sociodemographic characteristics and laboratory parameters related to HD.

Method
166 HD patients aged 68.5 (58.8-76) years, 55 women (33%) and 111 (67%) men with mean HD duration of 4 (2-6) years from 6 HD center were included in this study. For each study participant, data about body composition measured with BIA, laboratory, sociodemographic and clinical parameters were obtained. Also, body mass index (BMI) was calculated, and the Malnutrition Inflammation Score (MIS) used to assess nutritional status.

Results
Using an MIS cut-off point of 5 for malnutrition, 53% of patients were malnourished (MIS≥5). Therefore, those malnourished HD patients were significantly older (p = 0.001), with longer HD duration (p = 0.002), lower residual renal function (p = 0.02), waist circumference (p = 0.001), BMI (p &lt; 0.001), muscle (p = 0.002) and fat mass (p = 0.001) in kg, phase angle PhA (p &lt; 0.001), serum creatinine (p = 0.002), albumin (p = 0.008), phosphate (p = 0.01), and urate (p = 0.008) level but have significantly higher ferritin (p = 0.004), and mean cellular volume level (p = 0.02). Therefore, total MIS score significantly negatively correlated with HD duration (r = −0.247, p &lt; 0.001), waist circumference (r = −0.323, p &lt; 0.001),muscle mass (r = −0.236, p &lt; 0.001), fat mass (r = −0.352, p &lt; 0.001), serum creatinine (r = −0.271, p &lt; 0.001), phosphor (r = −0.245, p &lt; 0.001), urate (r = −0.344, p &lt; 0.001), and TIBC (r = −0.376, p &lt; 0.001), albumin (r = 0.241, p &lt; 0.001), ferritin (r = 0.273, p &lt; 0.001). In contrast, PhA significantly positively correlated with muscle mass (kg) (r = 0.311, p &lt; 0.001), creatinine (r = 0.313, p &lt; 0.001), phosphate (r = 0.208, p = 0.01), urate (r = 0.305, p = 0.01) and Total Iron Binding Capacity (TIBC) (r = 0.245, p &lt; 0.001) while significantly negative correlation with ferritin (r = −0.182, p = 0.03) was found. Also, there was a significant negative correlation between PhA and MIS (r = −0.362, p &lt; 0.001). A multivariate regression analysis showed that age (ß = 0.09, p = 0.005), waist circumference (ß = −0.09, p = 0.004), serum albumin (ß = −0.23, p = 0.04), and urate (ß = −0.01, p = 0.02), were predictive factors for malnutrition.

Conclusion
The prevalence of malnutrition in HD patients in Croatian HD population was high. These results indicate and highlight the urgent need for individualized and structural nutritional screening (using MIS score and PhA) and nutritional support in Croatian HD patients, especially for older HD patients and those with longer HD duration.