Nutritional Profile and Inflammatory Status of Hemodialysis Patients

BACKGROUND: Malnutrition and abnormal inflammatory markers are prominent features of the uremic syndrome, but associations and repercussions are somewhat controversial. OBJECTIVE: To determine nutritional and clinical profile of hemodialysis patients, aiming at potential diagnostic recommendations for stable subjects with elevated C-reactive protein. DESIGN: Prospective observational cross-sectional clinical study in a stable chronic hemodialysis population; SETTING: Renal and Nutritional Service of a mid-size charity academic hospital; PATIENTS: Subjects (n=44) were analyzed concerning nutritional status and C-reactive protein. Some displayed acute infections (Group I, n=9) and others did not (Group II, n=35). Age was 47.0 +/- 16.9 years with 63.6% males. Body mass index (BMI) was 22.2 +/- 3.9 kg/m2, calorie intake was 1262 +/- 601 kcal/day (20.7 +/- 6.7 kcal/kg/day), and protein ingestion was 74.3 +/- 16.6 g protein/day (1.2 g/kg/day); INTERVENTION: No nutritional supplement or artificial modality of alimentation was employed in this series; MAIN OUTCOME MEASURES: Subjective global assessment and C-reactive protein. RESULTS: Malnutrition estimated by subjective global assessment (SGA) was very common (>90%), despite acceptable BMI and serum albumin. C-reactive protein was moderately elevated in 40.9% and was positively associated with SGA and negatively with plasma proteins. Comorbidities were associated positively with extracellular water and negatively with reactance (bioimpedance). When infected versus non-infected cases were analyzed, 100% of the former displayed high CRP concentrations in contrast with 22.9% of remaining patients. CONCLUSIONS: (1) Malnutrition profile was rather unique, with relatively favorable objective findings (body mass index, serum albumin) and more deranged SGA; (2) Bioimpedance analysis suggested that phase angle could be used as an indicator of nutritional status; (3) Creactive protein was negatively associated with plasma proteins; (4) Infected subjects, although few and displaying moderate clinical troubles, were responsible for most C-reactive protein determinations above 8 mg/L; (5) Investigation of occult infectious foci is advised in these circumstances.