Evaluation of the Impact of Nutritional Support on Quality of Life and Morbidity Indicators in Hemodialysis

Abstract

Introduction: Protein-energy malnutrition is a predictor of morbidity and mortality in hemodialysis. Early nutritional intervention and appropriate clinical care are critical to reduce morbidity and improve quality of life in hemodialysis patients. Purpose: Evaluate the impact of nutritional assistance in hemodialysis services with full nutritional assistance (group 1) and partial nutritional assistance (group 2). Methods: A prospective cohort study of 56 patients (19 women and 37 men) followed-up for 12 months. There were 4 deaths, 4 kidney transplants, 6 transfers and 1 voluntary withdrawal, so that only 41 patients completed the study. Patients were assessed at the 3rd and 15th month of hemodialysis. Main inclusion criteria: Being on hemodialysis for at least 3 months and age ≥ 18 years. Instruments: Biochemical tests, SF-36, malnutrition-inflammation score, economic classification criteria of the Brazilian Association of Research Companies. Statistics analysis: were expressed as mean ± standard deviation, median, chi-square or Fisher’s exact test, Mann-Whitney test, “t”-Student test, Pearson’s correlation, ANOVA and Tukey’s multiple comparisons. Level of significance: p < 0.05. Results: Group 1 had a higher median age (p: 0.014). Group 2 and patients with indwelling catheter had higher median annual hospitalizations (5 and 6 days, p: 0.028 and 0.035, respectively). The malnutrition-inflammation score correlated negatively with albumin (r = -0.632, p: 0.000), and with SF-36 domains: physical functioning (r = -0.433, p: 0.001), physical aspects (r = -0.393, p: 0.003), general health (r = -0.412, p: 0.002), vitality (r = -0.338, p: 0.011), social functioning (r = -0.361, p: 0.006), emotional functioning (r = -0.278, p: 0.038), mental health (r = -0.313, p: 0.019), and positively with C-reactive protein (r = 0.479, p: 0.000). Conclusion: Results suggest that full nutritional assistance can have a positive influence, reducing morbidity and controlling nutritional disorders in hemodialysis.