The study on nutritional status in Korean hemodialysis patients

Abstract

Nutritional assessment and management has been recognized as an important therapeutic approach for hemodialysis(HD) patients, because poor nutritional status is associated with a poor prognosis of end stage renal disease(ESRD) patients. The purpose of this study was to examine the nutritional status of Korean HD patients. The subjects for this study were 110 HD patients (46 male and 64 female) and transferred from other center for hemodialysis care. The dietary intakes, anthropometric parameters and blood profiles were assessed. In this study, the mean age was 56.8 years old for males, and 59.9 years old for females, the mean HD duration was 4.8 years for males and 6.6 years for females. Primary cause of chronic renal failure was diabetes mellitus. (male: 52.2%, female: 40.6%) Mean body mass index (BMI) was in normal range (22.5kg/m2 for male, 21.8kg/m2 for female subjects) and prevalence of underweight(BMI <18.5kg/m2) was 12%. Compared to anthropometric standard values for Korean adult, none of male subjects belonged to triceps skin fold thicknesses (TSF)<5 percentile, however 64.7% of female subjects belonged to TSF<5 percentile. The proportion of male and female subjects belonged to mid arm muscle circumference (MAMC) < 5 percentile was 26.1 and 12.5% respectively. Mean energy/ideal body weight (IBW) intake (27.5kcal/kgIBW/d for male, 26.8kcal/kg IBW/d for female) and protein/IBW intake (1.1g/kgIBW/d for both genders) were below the recommendation intake by the National Kidney Foundation (NKF) Kidney Dialysis Outcome Quality Initiative (K/DOQI). The proportion of male and female subject taking less than 30~35kcal/ IBW(kg)/d for energy was 63%, 70.3% and less than 1.2g/ IBW(kg)/d for protein was 58.7% and 65.6%,respectively. The proportion of subjects taking less than Estimated Average Requirements (EAR) for calcium, vitamin B1, vitamin B2, vitamin C and folate was more than 50% for both genders. The proportion of subjects who belonged to hypoalbuminemia (<3.5g/dl) was 10.9% in male, 18.8% in female. The proportion of subjects who belonged to hypocholesterolemia(<150mg/dl) was 67.4% in male, 31.3% in female. The proportion of subjects who belonged to anemia was more than 90% for both genders. Dialysis adequacy was satisfactory (Kt/v for male and female: 1.3 and 1.6). Nutritional measurement was repeated after 6 months. Although changes in nutritional measures were observed in subjects, no significant change was found in proportion of subjects with malnutrition between initial and after 6months. The nutritional status of the subjects according to the cholesterol level (hypocholesterolemia group: cholesterol＜150 mg/ dl, normal cholesterol group: cholesterol 150-240mg/ dl) was examined. The hypocholesterolemia group significantly lower HDL cholesterol and LDL cholesterol than normal cholesterol group in male subjects. The hypocholesterolemia group showed significantly lower weight, BMI, percent ideal body weight (PIBW), Mid arm circumference (MAC), MAMC, serum triglyceride (TG) and LDL cholesterol than normal cholesterol group in female subjects. In the correlation between hemodialysis duration and anthropometric, blood profiles and nutrient intakes, hemodialysis duration significantly negatively correlated with BMI, MAC and TSF values. In conclusion, anthropometric, dietary intakes, blood profile of most hemodialysis patients were below recommended level. Therefore, nutritional status of subjects was not satisfactory, and active nutrition monitoring is urgently needed. Further research with a larger sample and for a longer follow up period is needed to expand our understanding of nutritional status for HD patients.;본 연구는 외래 혈액 투석 환자들의 영양상태를 조사하기 위하여 서울 시내 전문 인공신장실에서 혈액투석을 시행하고 있는 외래환자 110명을 대상으로 인체계측 및 생화학적 검사, 식이조사를 2007년 6월부터 2008년 3월까지 실시하였다. 대상자들의 평균 연령은 남자 대상자는 56.8세, 여자 대상자는 59.9세 이었고 평균 혈액투석기간은 남 4.8년, 여 6.6년이었다. 만성신부전의 원인질환은 당뇨병이 남 52.2% 여 40.6%로 가장 높은 비율을 차지했다. 평균 BMI는 남 22.5kg/m2, 여 21.8kg/m2로 정상범위 내에 있었고 대상자의 12%가 저체중이었다. 한국 정상인 수치와 비교하여 5 percentile 미만이 TSF는 남 0%, 여 64.7%, MAMC는 남 26.1%, 여 12.5%이었다. 이상체중당 에너지 섭취량은 남자 평균 27.5 kcal/kgIBW/d, 여자 26.8 kcal/kgIBW/d 이었고 이상체중당 단백질 섭취량은 남,여 대상자 모두 평균 1.1g/ kg IBW/d으로 National Kidney Foundation (NKF) Kidney Dialysis Outcome Quality Initiative (K/DOQI) 에서 제시한 권장량 미만이었다. K/DOQI에서 제시한 열량 30~35kcal/kgIBW/d 미만을 섭취한 비율은 남자 대상자는 63%, 여자 대상자는 70.3%였고 단백질 1.2g/kgIBW/d 미만을 섭취한 비율은 남자 58.7%, 여자 65.6% 로 나타났다. 칼슘, 비타민B1, 비타민B2, 비타민C 그리고 엽산의 섭취량은 대상자의 50%이상이 평균필요량 (EAR) 보다 부족하게 섭취하고 있어서 전반적인 영양소 섭취가 부족한 것을 확인할 수 있었다. 저알부민혈증 (albumin(g/dl)<3.5)에 속하는 대상자의 비율은 남 10.9%, 여 18.8% 였고 저콜레스테롤혈증 (cholesterol(mg/dl)<150)에 속하는 대상자의 비율은 남 67.4%, 여 31.3%였다. 빈혈 (hemoglobin(g/dl)<13 in male, hemoglobin(g/dl)<12 in female) 에 속하는 대상자의 비율은 남, 여 대상자 모두 90% 이상이었다. 투석적절도의 지표인 Kt/V 값은 남자 1.3, 여자 1.6으로, 여자가 남자보다 높았으며 남, 녀 대상자 모두 정상범위에 속하였다. 신체계측치와 영양소의 상관관계 분석에서 MAMC는 열량, 탄수화물, 지방, 비타민C 그리고 비타민E 섭취량과 양의 상관관계를 나타냈다. 혈액투석기간은 BMI, MAC 와 TSF 음의 상관관계를 보였다. 6개월 후에 69명에 대하여 재조사를 실시하여 영양상태의 변화를 살펴보았다. 대상자들의 인체계측 및 생화학적 검사, 식이섭취의 변화에도 불구하고 영양불량을 나타내는 대상자의 비율은 통계적으로 유의하게 변화되지 않았다. 결론적으로 혈액투석 환자들의 영양불량률은 그 판정기준에 따라 차이가 있었으나, 혈액투석 환자 중 상당수가 영양불량의 문제가 있음을 확인할 수 있었다. 그러므로 적절한 영양상태를 유지하기 위해서 열량, 단백질을 충분히 섭취하도록 강조하고, 개개인의 영양불량상태 개선을 위한 보다 많은 노력과 연구가 필요할 것으로 사료된다.