Nutritional Markers in Patients Undergoing Chronic Haemodialysis in Jamaica

Objectives: The main objective of the study is to assess the nutritional status in patients on chronic haemodialysis in Jamaica using the Subjective Global Assessment tool and to correlate this with measured serum nutritional biomarkers, and also to identify nutritional biomarkers that can be used to assess nutritional status of patients with end-stage renal disease (ESRD). Subject and Methods: Two hundred and nine consecutive patients on haemodialysis were selected from dialysis centres in Kingston, the capital of Jamaica, St Catherine and Manchester, Jamaica. The nutritional status of each participant was assessed using the Subjective Global Assessment tool in an interview performed by the researcher Serum albumin, blood urea nitrogen and creatinine, highly sensitive complement reactive protein (hsCRP) and total fasting cholesterol were determined from a single serum sample. Only patients with ESRD were selected. Patients with acute renal failure or those with ESRD who were admitted in the previous two weeks were excluded from the study. Informed consent was obtained prior to interview and obtaining blood samples. Results: Of the total participants, 54.5% (n = 114) were male and 45.5% (n = 95) female. The mean age for males was 51.9 years and females 47.6 years. Diabetes was documented as the most common cause of chronic renal disease and was found in 29.7%, hypertension in 24.4% and chronic glomerulonephritis in 22% of the participants. Approximately 80% of the study population had moderate malnutrition. There was a significant association between moderate malnutrition and a diagnosis of ESRD secondary to diabetes mellitus, p = 0.03. Being on haemodialysis for <= six months was significantly associated with moderate malnutrition p = 0.002. Also associated with moderate malnutrition were presence of an arteriovenous (AV) fistula (p = 0.01), serum albumin of < 40 g/L (OR 3.68, p = 0.001), pre-dialysis creatinine of < 880 mu mol/L (p = 0.02) and cholesterol < 3.9 mmol/L (p = 0.04). Highly sensitive complement reactive protein levels of > 10 mg/L was associated with moderate malnutrition, though statistical signifance was not met (p = 0.39). Conclusion: Factors associated with malnutrition in patients on dialysis were having ESRD secondary to diabetes mellitus, dialysis duration for <= six months, low serum albumin, pre-dialysis serum creatinine of 880 mu mol/L, low total cholesterol and presence of AV fistula access.