Dialysis Adequacy and Nutritional Status in Patients on Maintenance Hemodialysis

Abstract

Introduction
Dialysis adequacy and malnutrition are key factors contributing to high mortality and morbidity rate in maintenance hemodialysis patients. Previous studies from Nepal have reported very low mean spKt/V and very high malnutrition rates. However, contemporary data on these parameters are lacking in Nepalese patients. So, this study was done to assess the current status of adequacy of dialysis, nutritional status and to determine the association between them in dialysis population in a tertiary care center of Nepal.

Methods
A cross-sectional study was conducted among 118 maintenance hemodialysis patients at Tribhuvan University Teaching Hospital. Dialysis adequacy was measured using spKt/V and nutritional status was assessed using MQSGA, anthropometric measurements and serum albumin. Chi-squared test, t-test and logistic regression analysis were done to determine independent factors associated with inadequate dialysis.

Results
The mean spKt/V was 1.3 ± 0.36, with 59.3% of patients achieved adequate dialysis. MQSGA showed that 62.7% of patients had normal nutrition, while 37.3% had mild-to-moderate malnutrition and none had severe malnutrition. Mid arm circumference and mid arm muscle circumference were significantly higher in patients with adequate dialysis. On logistic regress analysis, mid arm circumference was found to be an independent risk factor associated with inadequate hemodialysis (p = 0.03). MQSGA, triceps skinfold thickness, biceps skinfold thickness and serum albumin did not show significant associations.

Conclusions
Despite improvements in dialysis adequacy and nutritional status over time, many patients continue to receive inadequate dialysis and have malnutrition. Dialysis adequacy is significantly associated with objective measures of muscle mass rather than subjective nutritional scores, highlighting the importance of incorporating simple anthropometric assessments into routine care.