Inadequacy of dialysis, chronic inflammation and malnutrition in Nigerian patients on chronic hemodialysis.
OBJECTIVE
To identify the extent of underdialysis, chronic inflammation and malnutrition and their interrelationships in Nigerian hemodialysis patients.


METHODS
In a prospective study including 10 adult patients, (6 men, 4 women) on hemodialysis in North Central Nigeria, malnutrition was assessed by body mass index (BMI), serum albumin and prealbumin, and bioimpedance (BIA) pre-and post dialysis, inflammation was evaluated by C-reactive protein (CRP) and adequacy of dialysis was judged by frequency of the hemodialysis sessions and Kt/V urea.


RESULTS
Post-dialysis BMI was 21.3 (19.9, 24.3) kg/m2 (< 20 kg/m2 in 4 patients), serum albumin 31.5 (24.0, 32.0) g/L (< 30.0 g/L in 5), serum pre-albumin 25.2 (15.3, 31.1) mg/dL (< 18.0 mg/dL in 4), serum CRP 4.8 (1.2, 11.5) mg/dL (> 1.0 mg/dL in 8), phase angle 4.2 (3.7, 5.1) degrees (< 3 degrees in 3) and body fat deficit was diagnosed by BIA in 4 patients. Weekly frequency of dialysis was 3 times in 2 patients, twice in 1 and <or= 1 time in 7. Single-pool Kt/V urea was 0.81 (0.68, 0.95, <1.2 in 9 patients and > 1.2 in one patient receiving dialysis only twice weekly). By combined frequency of dialysis and Kt/V urea values, no patient received an adequate dose of dialysis and, indeed, all patients had overt symptoms of uremia. Low body weight, low serological and BIA nutrition indices, and high CRP levels occurred in the same patients. Patients on dialysis for > 1 year had worse nutrition indices than those on dialysis for < 1 year.


CONCLUSIONS
Underdialysis was universal, while poor nutrition and chronic malnutrition were found in the majority of the small number of patients studied. These three adverse conditions, which were interlinked, may be common in Nigerian hemodialysis patients, because their underlying socioeconomic causes are widespread.
Tzamaloukas
A H
AH
Medicine Service, New Mexico VA Health Care System and Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87108, USA. Tzamalouka@aol.com
Vanderjagt
D J
DJ
Agaba
E I
EI
Ma
I
I
Lopez
A
A
Tzamaloukas
R A
RA
Murata
G H
GH
Glew
R H
RH
D000328:Adult; D000418:Albumins / Q000032:analysis; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008875:Middle Aged; D009752:Nutritional Status; D011228:Prealbumin / Q000032:analysis; D011446:Prospective Studies; D006435:Renal Dialysis; D017211:Treatment Failure
D000418:Albumins; D011228:Prealbumin; D002097:C-Reactive Protein