title: DETECTION OF MALNUTRITION IN PATIENTS UNDERGOING MAINTENANCE HAEMODIALYSIS: A QUANTITATIVE DATA ANALYSIS ON 12 PARAMETERS.
abstract: BACKGROUND
  Protein-energy-malnutrition (PEM) is common in people with end stage kidney disease (ESKD) undergoing maintenance haemodialysis (MHD) and correlates strongly with mortality. To this day, there is no gold standard for detecting PEM in patients on MHD.
  
  
  OBJECTIVE
  The aim of this study was to evaluate if Nutritional Risk Screening 2002 (NRS-2002), handgrip strength measurement, mid-upper arm muscle area (MUAMA), triceps skin fold measurement (TSF), serum albumin, normalised protein catabolic rate (nPCR), Kt/V and eKt/V, dry body weight, body mass index (BMI), age and time since start on MHD are relevant for assessing PEM in patients on MHD.
  
  
  METHODS
  The predictive value of the selected parameters on mortality and mortality or weight loss of more than 5% was assessed. Quantitative data analysis of the 12 parameters in the same patients on MHD in autumn 2009 (n = 64) and spring 2011 (n = 40) with paired statistical analysis and multivariate logistic regression analysis was performed.
  
  
  RESULTS
  Paired data analysis showed significant reduction of dry body weight, BMI and nPCR. Kt/Vtot did not change, eKt/v and hand grip strength measurements were significantly higher in spring 2011. No changes were detected in TSF, serum albumin, NRS-2002 and MUAMA. Serum albumin was shown to be the only predictor of death and of the combined endpoint "death or weight loss of more than 5%".
  
  
  CONCLUSIONS
  We now screen patients biannually for serum albumin, nPCR, Kt/V, handgrip measurement of the shunt-free arm, dry body weight, age and time since initiation of MHD.
authors.affiliation: Bern University of Applied Sciences, Bern, Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Nafzger
authors.affiliation: Bern University of Applied Sciences, Bern, Switzerland.
authors.forename: Lea-Angelica
authors.initials: LA
authors.lastname: Fleury
authors.affiliation: Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Dominik E
authors.initials: DE
authors.lastname: Uehlinger
authors.affiliation: Department of Endocrinology, Diabetology and Clinical Nutrition, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Petra
authors.initials: P
authors.lastname: Plüss
authors.affiliation: Bern University of Applied Sciences, Bern, Switzerland.
authors.forename: Ninetta
authors.initials: N
authors.lastname: Scura
authors.affiliation: Department of Endocrinology, Diabetology and Clinical Nutrition, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Kurmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001806:Blood Urea Nitrogen; D001837:Body Weights and Measures; D004044:Dietary Proteins / Q000378:metabolism*; D005260:Female; D018737:Hand Strength; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data*; D012709:Serum Albumin / Q000032:analysis; D014508:Urea / Q000378:metabolism
chemical_list: D004044:Dietary Proteins; D012709:Serum Albumin; D014508:Urea
keywords: Haemodialysis; Malnutrition; Nutritional Assessment