Major barriers responsible for malnutrition in hemodialysis patients: challenges to optimal nutrition.
BACKGROUND
Nutritional barriers may contribute to malnutrition in hemodialysis (HD) patients. Higher rates of morbidity and mortality rates have been reported in malnourished HD patients. These patients are faced with different challenges affecting their nutritional status.


OBJECTIVE
The aim of this cross-sectional study was to identify most important barriers responsible for malnutrition in HD patients.


METHODS
We randomly selected 255 of 800 stable HD patients from three HD centers with an age range of 18-85 years, who had been on hemodialysis for at least three months without any acute illness. Each patient was interviewed to evaluate malnutrition [subjective global assessment (SGA), malnutrition inflammation score (MIS)], and potential medical, behavioral and socioeconomic barriers. Body composition of patients was checked through bioelectrical impedance analysis (BIA). Routine clinical markers of malnutrition such as serum albumin and total protein were measured using standard automated techniques. Binary logistic regression model was used to find the association between nutritional markers and potential barriers.


RESULTS
Patients with higher SGA had lower knowledge about general nutrition [odds ratio (OR), 1.3], potassium (OR, 1.89), difficulty chewing (OR, 1.16), and shopping (OR, 1.16). Those with greater MIS scores had poor appetite (OR, 1.3), depression (OR, 1.21), and difficulty with cooking (OR, 1.15). Lower BCM (body cell mass) was associated with poor appetite (OR, 0.92) and needed help for cooking (OR, 0.88). Patients with higher BFMI (body fat mass index) had insufficient general nutrition (OR, 1.15), and protein (OR, 1.27) knowledge, and needed help for shopping (OR, 1.14). Moreover, patients with higher SGA scores were those with older age and longer duration of HD.


CONCLUSIONS
Three medical barriers (poor appetite, depression and difficulty chewing), one behavioral barrier (poor total nutrition, protein, and potassium knowledge), and one socioeconomic barrier (needing help for shopping and cooking) were independently associated with nutritional markers.
Department of Clinical Nutrition, Shiraz School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran.
Maryam
M
Ekramzadeh
Department of Clinical Nutrition, Shiraz School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran.
Zohreh
Z
Mazloom
Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, IR Iran.
Peyman
P
Jafari
Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.
Maryam
M
Ayatollahi
Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.
Mohammad Mahdi
MM
Sagheb
Anorexia; Hemodialysis; Malnutrition; Uremia