J Nutr Health.  2024 Oct;57(5):481-495. 10.4163/jnh.2024.57.5.481.

Malnutrition risk, nutritional knowledge, and dietary intake in chronic kidney disease patients on hemodialysis: comparison according to coexisting diabetes

• Yoo H
• Lee SC
• Kim HK

• KMID: 2561293
• DOI: http://doi.org/10.4163/jnh.2024.57.5.481

Abstract

Purpose
Malnutrition is a prevalent condition leading to a high risk of morbidity and mortality in hemodialysis patients. This study examined the malnutrition risk and the influence of diabetes on clinical characteristics, nutritional knowledge, and dietary intake in chronic kidney disease (CKD) patients on hemodialysis.
Methods
Seventy-six patients (37 with diabetes and 39 without diabetes) enrolled in an internal medicine hemodialysis unit in Seoul were examined. A questionnaire, anthropometric, biochemical, and three-day dietary record data were collected. The nutritional risk was screened by the Patient-Generated Subjective Global Assessment (PG-SGA), compared to the Global Leadership Initiative on Malnutrition (GLIM).
Results
The overall prevalence of malnutrition was 56.6% and 27.6% by PG-SGA and GLIM, respectively, showing the low sensitivity (34.9%) and agreement (kappa = 0.16) of GLIM compared to the PG-SGA. CKD patients with diabetes had a higher malnutrition risk and more comorbidities than those without diabetes (p < 0.05). More than 60% of patients had anemia and hypocholesterolemia. Despite the fair level of nutritional knowledge, the intakes of energy per ideal body weight, calcium, vitamin A, vitamin B 6 , folate, and vitamin C were below the nutritional guidelines for hemodialysis patients in more than 70% of the patients. When stratified according to sex, female patients showed marked differences, with lower energy, protein, fat, calcium, phosphorus, vitamin B 2 , folate, and vitamin B 12 intakes in diabetic patients compared to non-diabetic patients. The most challenging aspect of diet therapy for hemodialysis patients was achieving the appropriate protein intake for diabetic patients and restricting phosphorus intake for non-diabetic patients (p < 0.05).
Conclusion
These findings suggest that attention should be paid to the malnutrition of diabetic hemodialysis patients. Individualized nutritional counseling and management are needed for the nutritional care of hemodialysis patients to address the nutritional deficiency.

Keyword

chronic kidney diseases; hemodialysis; diabetes mellitus; malnutrition