NUTRITIONAL STATUS OF PATIENTS ON HEMODIALYSIS AT NAKURU COUNTY REFFERAL AND TEACHING HOSPITAL, KENYA
Abstract
Background: Patients on haemodialysis are faced with many challenges, including malnutrition. According to World Health Organization, the malnutrition rate varies significantly among patients attending haemodialysis, ranging from 18 to 75%. Malnutrition has been associated with increased adverse outcomes among patients, which prompts the need to control patient nutritional status. The common adverse outcomes include low quality of life, increased risk of infection, diseases, and slow wound healing. There has been less focus on malnutrition among patients attending Hemodialysis in Kenya, which forms the basis of this study.
Purpose of the study: To investigate determinants of malnutrition in hemodialysis patients at Nakuru county Referral and Teaching Hospital.
Methodology: The study utilized analytical cross-sectional study design. A consecutive sampling technique will be used to recruit 61 patients attending haemodialysis will be recruited randomly at Nakuru Referral and Teaching hospital dialysis unit. Binary logistic regression was conducted to investigate predictors of malnutrition in patients attending Hemodialysis. A Statistical Package for Social Sciences (SPSS) version 25 was used to conduct data analysis. A 95% confidence level was be considered.
Results: The present study has established that majority of patients were male with an average age of 56.2 years. Almost a third of the patients had both diabetes and hypertension. The findings also revealed that the average length of duration at the facility was 52 months. The findings showed that the prevalence of malnutrition was 39.3%. Among these, 26.2%of the HD patients had moderate malnutrition while 13.1% had severe malnutrition. The independent determinants of malnutrition included being male, having both hypertension and diabetes, presence of anemia, and poor dietary intake were determinants of malnutrition among HD patients.
Conclusion and recommendations: The findings established that malnutrition among patients on hemodialysis was high which warrants the need to develop tailored management approaches based on presenting risks.Keywords
Full Text:
PDFReferences
Bl, A., Vd, A., Vigan, J., Ba, S., Ahoui, S., Cg, A., & Djrolo, F. (2015). Assessing the Nutritional Status of Hemodialysis Patients in a Sub-Saharan country. 3(2), 1–5. https://doi.org/10.4172/2472-1220.1000145
Bramania, P. K., Ruggajo, P., Bramania, R., Mahmoud, M., & Furia, F. F. (2020). Prevalence of malnutrition inflammation complex syndrome among patients on maintenance haemodialysis at Muhimbili National Hospital in Tanzania: a cross-sectional study. BMC Nephrology. https://doi.org/10.1186/s12882-020-02171-3
Carrero, J. J., Stenvinkel, P., Cuppari, L., Ikizler, T. A., Kalantar-Zadeh, K., Kaysen, G., Mitch, W. E., Price, S. R., Wanner, C., Wang, A. Y. M., Ter Wee, P., & Franch, H. A. (2013). Etiology of the Protein-Energy Wasting Syndrome in Chronic Kidney Disease: A Consensus Statement From the International Society of Renal Nutrition and Metabolism (ISRNM). In Journal of Renal Nutrition. https://doi.org/10.1053/j.jrn.2013.01.001
Chan, M., Kelly, J., Batterham, M., & Tapsell, L. (2012). Malnutrition (Subjective Global Assessment) Scores and Serum Albumin Levels, but not Body Mass Index Values, at Initiation of Dialysis are Independent Predictors of Mortality: A 10-Year Clinical Cohort Study. Journal of Renal Nutrition. https://doi.org/10.1053/j.jrn.2011.11.002
Chan, Y., Mohd Shariff, Z., Lim, C., & Goh, B. (2019). Factors associated with poor nutritional status among hemodialysis patients in Malaysia. Malaysian Journal of Medicine and Health Sciences.
Chauhan, R., & Mendonca, S. (2015). Adequacy of twice-weekly Hemodialysis in end stage renal disease patients at a tertiary care dialysis centre. Indian Journal of Nephrology. https://doi.org/10.4103/0971-4065.151762
Chironda, G., & Bhengu, B. (2016). Contributing Factors to Non-Adherence among Chronic Kidney Disease (CKD) Patients: A Systematic Review of Literature. Medical & Clinical Reviews, 02(04). https://doi.org/10.21767/2471-299x.1000038
Clark-Cutaia, M. N., Sevick, M. A., Thurheimer-Cacciotti, J., Hoffman, L. A., Snetselaar, L., Burke, L. E., & Zickmund, S. L. (2019). Perceived Barriers to Adherence to Hemodialysis Dietary Recommendations. Clinical Nursing Research. https://doi.org/10.1177/1054773818773364
Corkins, M. R., Guenter, P., Dimaria-Ghalili, R. A., Jensen, G. L., Malone, A., Miller, S., Patel, V., Plogsted, S., & Resnick, H. E. (2014). Malnutrition diagnoses in hospitalized patients: United States, 2010. Journal of Parenteral and Enteral Nutrition. https://doi.org/10.1177/0148607113512154
Costa, C. A. D., Garcia, P. C. R., Cabral, D. D., Tonial, C. T., Bruno, F., Enloft, P. R., & Velozo, K. D. S. (2018). Reducing malnutrition in critically ill pediatric patients. Revista Brasileira de Terapia Intensiva. https://doi.org/10.5935/0103-507X.20180034
Dąbrowska-Bender, M., Dykowska, G., Żuk, W., Milewska, M., & Staniszewska, A. (2018). The impact on quality of life of dialysis patients with renal insufficiency. Patient Preference and Adherence. https://doi.org/10.2147/PPA.S156356
Daugirdas, J. T. (2017). Hemodialysis Treatment Time: As Important as it Seems? Seminars in Dialysis. https://doi.org/10.1111/sdi.12575
Deif, H. I. A., Elsawi, K., Selim, M., & NasrAllah, M. M. (2015). Effect of an Educational Program on Adherence to Therapeutic Regimen among Chronic Kidney Disease Stage 5 (CKD5) Patients under Maintenance Hemodialysis. Journal of Education and Practice, 6(5), 21–34.
Ekramzadeh, M., Mazloom, Z., Jafari, P., Ayatollahi, M., & Sagheb, M. M. (2014). Major barriers responsible for malnutrition in hemodialysis patients: Challenges to optimal nutrition. Nephro-Urology Monthly. https://doi.org/10.5812/numonthly.23158
Espahbodi, F., Khoddad, T., & Esmaeili, L. (2014). Evaluation of malnutrition and its association with biochemical parameters in patients with end stage renal disease undergoing Hemodialysis using subjective global assessment. Nephro-Urology Monthly. https://doi.org/10.5812/numonthly.16385
Faten, M., Ramla, M., Nadia, B. A., Mongi, B. M., Adel, K., Inès, L., & Henda, J. (2019). Prevalence of malnutrition for elderly hemodialysis patients. Tunisie Medicale.
Fouque, D., Kalantar-Zadeh, K., Kopple, J., Cano, N., Chauveau, P., Cuppari, L., Franch, H., Guarnieri, G., Ikizler, T. A., Kaysen, G., Lindholm, B., Massy, Z., Mitch, W., Pineda, E., Stenvinkel, P., Trevinho-Becerra, A., & Wanner, C. (2008). A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney International. https://doi.org/10.1038/sj.ki.5002585
Freitas, A. T. V. de S., Vaz, I. M. F., Ferraz, S. F., Peixoto, M. do R. G., & Campos, M. I. V. M. (2014). Prevalence of malnutrition and associated factors in hemodialysis patients. Revista de Nutricao. https://doi.org/10.1590/1415-52732014000300009
Ghorbani, A., Hayati, F., Karandish, M., & Sabzali, S. (2020). The prevalence of malnutrition in hemodialysis patients. Journal of Renal Injury Prevention. https://doi.org/10.34172/jrip.2020.15
Grossniklaus, D. A., O’Brien, M. C., Clark, P. C., & Dunbar, S. B. (2008). Nutrient intake in heart failure patients. Journal of Cardiovascular Nursing. https://doi.org/10.1097/01.JCN.0000317433.52210.e0
Hakim, R. M., & Saha, S. (2014). Dialysis frequency versus dialysis time, that is the question. In Kidney International. https://doi.org/10.1038/ki.2013.474
Hamid, A., Dhrolia, M. F., Imtiaz, S., Qureshi, R., & Ahmad, A. (2019). Comparison of adequacy of dialysis between single-use and reused hemodialyzers in patients on maintenance hemodialysis. Journal of the College of Physicians and Surgeons Pakistan. https://doi.org/10.29271/jcpsp.2019.08.720
Huang, B., Lai, B., Xu, L., Wang, Y., Cao, Y., Yan, P., & Chen, J. (2017). Low employment and low willingness of being reemployed in Chinese working-age maintained hemodialysis patients. Renal Failure. https://doi.org/10.1080/0886022X.2017.1361834
Ibrahim, S., Hossam, M., & Belal, D. (2015). Study of non-compliance among chronic hemodialysis patients and its impact on patients’ outcomes. Saudi Journal of Kidney Diseases and Transplantation : An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 26(2), 243–249. https://doi.org/10.4103/1319-2442.152405
Kadiri, M. E. M. bark., Nechba, R. B., & Oualim, Z. (2011). Factors predicting malnutrition in hemodialysis patients. Saudi Journal of Kidney Diseases and Transplantation : An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia.
Karavetian, M., Elzein, H., Rizk, R., Jibai, R., & de Vries, N. (2016). Nutritional education for management of osteodystrophy: Impact on serum phosphorus, quality of life, and malnutrition. Hemodialysis International. https://doi.org/10.1111/hdi.12405
Kistler, B. M., Fitschen, P. J., Ikizler, T. A., & Wilund, K. R. (2015). Rethinking the restriction on nutrition during hemodialysis treatment. In Journal of Renal Nutrition. https://doi.org/10.1053/j.jrn.2014.08.008
Ko, Y. E., Yun, T., Lee, H. A., Kim, S. J., Kang, D. H., Choi, K. B., Kim, Y. S., Kim, Y. L., Oh, H. J., & Ryu, D. R. (2018). Gender-specific discrepancy in subjective global assessment for mortality in hemodialysis patients. Scientific Reports. https://doi.org/10.1038/s41598-018-35967-3
Kohlová, M., Amorim, C. G., Araújo, A., Santos-Silva, A., Solich, P., & Montenegro, M. C. B. S. M. (2019). The biocompatibility and bioactivity of hemodialysis membranes: their impact in end-stage renal disease. In Journal of Artificial Organs. https://doi.org/10.1007/s10047-018-1059-9
Krespi, R., Bone, M., Ahmad, R., Worthington, B., & Salmon, P. (2004). Haemodialysis patients’ beliefs about renal failure and its treatment. Patient Education and Counseling, 53(2), 189–196. https://doi.org/10.1016/S0738-3991(03)00147-2
Kwon, Y. E., Kee, Y. K., Yoon, C. Y., Han, I. M., Han, S. G., Park, K. S., Lee, M. J., Park, J. T., Han, S. H., Yoo, T. H., Kim, Y. L., Kim, Y. S., Yang, C. W., Kim, N. H., & Kang, S. W. (2016). Change of nutritional status assessed using subjective global assessment is associated with all-cause mortality in incident dialysis patients. Medicine (United States). https://doi.org/10.1097/MD.0000000000002714
Lacson, E., & Lazarus, J. M. (2006). Dialyzer best practice: Single-use or reuse? Seminars in Dialysis. https://doi.org/10.1111/j.1525-139X.2006.00137.x
Lopes, A. A., Elder, S. J., Ginsberg, N., Andreucci, V. E., Cruz, J. M., Fukuhara, S., Mapes, D. L., Saito, A., Pisoni, R. L., Saran, R., & Port, F. K. (2007). Lack of appetite in haemodialysis patients - Associations with patient characteristics, indicators of nutritional status and outcomes in the international DOPPS. Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfm453
Lynch, K. E., Lynch, R., Curhan, G. C., & Brunelli, S. M. (2013). Altered Taste Perception and Nutritional Status Among Hemodialysis Patients. Journal of Renal Nutrition. https://doi.org/10.1053/j.jrn.2012.08.009
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., Gervasio, J. M., Sacks, G. S., Roberts, P. R., & Compher, C. (2016). Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition. https://doi.org/10.1177/0148607115621863
Moussa, H. D., Tondi, Z. M. M., Kane, Y., Sani, M. A. M., Abdou, I., Touré, I., Illa, A., & Omar, A. E. (2016). Assessing the Nutritional Status of Hemodialysis Patients in Sub-Saharan Africa: Experience of Two Hemodialysis Centers in Niger. Open Journal of Nephrology, 06(04), 161–166. https://doi.org/10.4236/ojneph.2016.64021
National Kidney Foundation. (2019). Clinical Practice Guideline for Nutrition in Chronic Kidney Disease: 2019 Update. Academy of Nutrition and Dietetics.
Norhayati, I., Rafidah, A. P. M., Sharlene, T., Normah, C. D., Halim, A. A. G., Rozmi, I., & Zahara, A. M. (2016). Association between health-related quality of life and psychological distress at different stages of chronic kidney disease. Sains Malaysiana, 45(5), 753–759. https://www.scopus.com/inward/record.uri?eid=2-s2.0-84975256708&partnerID=40&md5=16e1eb875ecddc5006182d71bc21d0f6
Oluseyi, A., & Enajite, O. (2016). Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria .
Opiyo, R. O., Nyasulu, P. S., Olenja, J., Zunza, M., Nguyen, K. A., Bukania, Z., Nabakwe, E., Mbogo, A., & Were, A. O. (2019). Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on Hemodialysis in national referral hospitals in Kenya: a mixed-methods survey. Renal Replacement Therapy, 5(1), 1–14. https://doi.org/10.1186/s41100-019-0237-4
Palmer, S. C., Hanson, C. S., Craig, J. C., Strippoli, G. F. M., Ruospo, M., Campbell, K., Johnson, D. W., & Tong, A. (2015). Dietary and fluid restrictions in CKD: A thematic synthesis of patient views from qualitative studies. American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2014.09.012
Park, G. Y., & Yoo, E. K. (2016). A study on quality of life in hemodialysis patients. Information (Japan). https://doi.org/10.5455/msm.2015.27.305-309
Rashidi, A. A., Soleimani, A. R., Nikoueinejad, H., & Sarbolouki, S. (2013). The evaluation of increase in hemodialysis frequency on C-reactive protein levels and nutritional status. Acta Medica Iranica.
Reza, H. M., Shuvo, S. Das, & Ahmad, T. (2018). Assessing the prevalence of malnutrition in chronic kidney disease patients undergoing Hemodialysis in Kushtia District, Bangladesh. Nutrition and Food Science. https://doi.org/10.1108/NFS-05-2017-0103
Rezeq, H. A., Khdair, L. N., Hamdan, Z. I., & Sweileh, W. M. (2018). Prevalence of malnutrition in hemodialysis patients: A single-center study in Palestine. Saudi Journal of Kidney Diseases and Transplantation : An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia. https://doi.org/10.4103/1319-2442.229264
Ribeiro, I. C., Roza, N. A. V., Duarte, D. A., Guadagnini, D., Elias, R. M., & Oliveira, R. B. de. (2019). Clinical and microbiological effects of dialyzers reuse in hemodialysis patients. Jornal Brasileiro de Nefrologia : ’orgao Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia. https://doi.org/10.1590/2175-8239-JBN-2018-0151
Rocco, M., Daugirdas, J. T., Depner, T. A., Inrig, J., Mehrotra, R., Rocco, M. V., Suri, R. S., Weiner, D. E., Greer, N., Ishani, A., MacDonald, R., Olson, C., Rutks, I., Slinin, Y., Wilt, T. J., Kramer, H., Choi, M. J., Samaniego-Picota, M., Scheel, P. J., … Brereton, L. (2015). KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update. American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2015.07.015
Sabatino, A., Regolisti, G., Karupaiah, T., Sahathevan, S., Sadu Singh, B. K., Khor, B. H., Salhab, N., Karavetian, M., Cupisti, A., & Fiaccadori, E. (2017). Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on Hemodialysis. In Clinical Nutrition. https://doi.org/10.1016/j.clnu.2016.06.007
Slinin, Y., Guo, H., Gilbertson, D. T., Mau, L. W., Ensrud, K., Collins, A. J., & Ishani, A. (2011). Prehemodialysis care by dietitians and first-year mortality after initiation of Hemodialysis. American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2011.03.032
Spatola, L., Finazzi, S., Calvetta, A., Reggiani, F., Morenghi, E., Santostasi, S., Angelini, C., Badalamenti, S., & Mugnai, G. (2018). Subjective Global Assessment-Dialysis Malnutrition Score and cardiovascular risk in hemodialysis patients: an observational cohort study. Journal of Nephrology. https://doi.org/10.1007/s40620-018-0505-3
Strokov, A. G., & Poz, I. L. (2018). High dialysis membranes permeability: Pluses and minuses. Vestnik Transplantologii i Iskusstvennykh Organov. https://doi.org/10.15825/1995-1191-2018-4-100-106
Sualeheen, A., Khor, B. H., Balasubramanian, G. V., Sahathevan, S., Ali, M. S. M., Narayanan, S. S., Chinna, K., Daud, Z. A. M., Khosla, P., Gafor, A. H. A., Karupaiah, T., Cheak, B. B., Ahmad, G., Goh, B. L., Lim, S. K., Visvanathan, R., Yahya, R., Bavanandan, S., & Morad, Z. (2020). Habitual Dietary Patterns of Patients on Hemodialysis Indicate Nutritional Risk. Journal of Renal Nutrition. https://doi.org/10.1053/j.jrn.2019.09.010
Susetyowati, S., Djarwoto, B., & Faza, F. (2017). Nutrition screening tools as predictor of malnutrition for hemodialysis patients in Dr. Sardjito Hospital in Yogyakarta, Indonesia. Saudi Journal of Kidney Diseases and Transplantation : An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia. https://doi.org/10.4103/1319-2442.220871
Tan, S. K., Loh, Y. H., Choong, H. L., & Suhail, S. M. (2016). Subjective global assessment for nutritional assessment of hospitalized patients requiring haemodialysis: A prospective cohort study. Nephrology. https://doi.org/10.1111/nep.12707
Tavares, A. P. dos S. R., Mafra, D., Leal, V. de O., Gama, M. dos S., Vieira, R. M. M. de F., Brum, I. D. S. da C., Borges, N. A., & Silva, A. A. (2020). Zinc Plasma Status and Sensory Perception in Nondialysis Chronic Kidney Disease Patients. Journal of Renal Nutrition. https://doi.org/10.1053/j.jrn.2020.05.012
Tentori, F., Zhang, J., Li, Y., Karaboyas, A., Kerr, P., Saran, R., Bommer, J., Port, F., Akiba, T., Pisoni, R., & Robinson, B. (2012). Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfs021
Tuegel, C., & Bansal, N. (2017). Heart failure in patients with kidney disease. In Heart. https://doi.org/10.1136/heartjnl-2016-310794
vanden Wyngaert, K., Celie, B., Calders, P., Eloot, S., Holvoet, E., Van Biesen, W., & Van Craenenbroeck, A. (2019). FP746Associations between the measures of physical function, the risk of falls and nutritional status of haemodialysis patients: a cross-sectional study. Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfz106.fp746
Wolf, Z. R., & Bailey, D. N. (2013). Paterson and Zderad’s Humanistic Nursing Theory: Concepts and Applications. International Journal of Human Caring. https://doi.org/10.20467/1091-5710.17.4.60
Zimmerer, J. L., Leon, J. B., Covinsky, K. E., Desai, U., & Sehgal, A. R. (2003). Diet monotony as a correlate of poor nutritional intake among hemodialysis patients. Journal of Renal Nutrition. https://doi.org/10.1053/jren.2003.50025
Refbacks
- There are currently no refbacks.
Copyright (c) 2025 Justin Mose Magara
© Numid Publishers ISSN: 2518-8631