Nutritional Status in Patients on Hemodialysis Program in Iraq

Abstract

Background: Malnutrition is a commonly encountered issue in patients with chronic kidney disease (CKD) and significantly impacts disease progression and mortality. We aimed to assess the prevalence and severity of malnutrition among Iraqi patients on a regular hemodialysis (HD) program. Aim: This study aims to evaluate the level of malnutrition among hemodialysis patients across all Iraqi centers. Methods: A cross-sectional study conducted across all Iraqi cities from January 1 to December 31, 2023, examined patients undergoing HD. A standardized questionnaire was utilized for data collection, which was centralized through governorate centers. Results: Using subjective global assessment (SGA), 3,639 patients (33.9%) in Group A (well-nourished), comprised 2,053 (19.15%) males and 1,586 females (14.79%). Group B (mild/moderately malnourished) with 4,526 patients (42.2%) included 2,399 males (22.38%) and 2,127 females (19.84%). Group C (severely malnourished) with 2,556 (23.8%) patients included 1,544 males (14.4%) and 1,012 females (9.4%). The pre-dialysis weight for males was 68.55 ± 11.37 kg, while it was 66.62 ± 11.95 kg for females. The post-dialysis weight after ultrafiltration was 66.95 ± 11.6 kg for males and 64.76 ± 12.09 kg for females. The mean height for males was 169.2 ± 7.15 cm, while females had a mean height of 155.75 ± 5.82 cm. The body mass index (BMI) among males was lower than that of females, with means of 23.18 ± 4.32 and 26.03 ± 5.12, respectively. Cholesterol levels indicated that female patients had higher levels than male patients, with mean cholesterol levels of 195.3 ± 18.24 mg/dL for males and 210.72 ± 39.55 mg/dL for females. Additionally, the serum albumin level for male patients was 3.32 ± 0.43, lower than that of female patients. Pre-dialysis renal function tests indicated blood urea levels of 182.83 ± 42.67 mg/dL for males and 182.13 ± 55.76 mg/dL for females. Serum creatinine levels were 8.8 ± 2.5 mg/dL for males and 7.2 ± 2.51 mg/dL for females. Serum calcium levels were higher among male patients, with a mean of 7.27 ± 2.1 mg/dL, while among female patients, the mean serum calcium level was 7.09 ± 1.89 mg/dL. Hematocrit (Hct) levels for male patients averaged 27.18 ± 5.07, while female patients had a mean Hct level of 27.9 ± 6.08. Conclusion: The study found that 66.1% participants exhibited some form of malnutrition, consistent with trends observed across the Middle East. Low serum albumin levels were identified, reflecting an inverse relationship between albumin levels and nutritional status. The prevalence is highlighted, attributed to factors, such as chronic inflammation, altered nutrient metabolism, and deficiencies in key nutrients.