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The predictive value of malnutrition for functional and cognitive status in elderly hemodialysis patients

  • Irina Mihaela Abdulan
  • Mihai Onofriescu
  • Ramona Stefaniu
  • Alexandra Mastaleru
  • Veronica Mocanu
  • Ioana-Dana Alexa
  • Adrian Covic
Nephrology - Original Paper
  • 14 Downloads

Abstract

Objective

The study aims to objectively and precisely describe, in elderly dialysis patients from a single center, the prevalence of malnutrition and severe cognitive/functional impairment and to establish the prognostic role of malnutrition assessment for patient’s severe cognitive/functional status.

Design

Cross-sectional study.

Setting

A single dialysis center from north-eastern Romania.

Subjects

Eighty-one elderly ambulatory hemodialysis patients.

Intervention

The aim of the study was to establish in hemodialysis elderly patients a correlation between two malnutrition scores [Mini Nutritional Assessment (MNA) and Subjective Global Assessment (SGA)] and geriatric tests (Geriatric Depression Scale—GDS), daily activities (Activities of Daily Living—ADL, Instrumental Activities of Daily Living—IADL), and cognitive impairment scores (Mini Mental State Examination—MMSE). A correlation between objective malnutrition parameters (bioimpedance lean tissue index (LTI) and fat tissue index (FTI) by bioimpedance) was also assessed.

Main outcome measure

Using area under the curve analysis, two malnutrition scores and bioimpedance assessed nutritional status were explored as possible predictors for the most severe category of functional and cognitive status.

Results

All patients had mild/moderate malnutrition by SGA, while the MNA test reported malnutrition in 14.5%, and 58% of cases. There was no correlation between subjective scores and objective biomarkers of malnutrition (albumin levels, bioimpedance-derived LTI, FTI). ROC curve analysis showed that MNA and SGA predict the most severe category of depression and functional impairment with relatively good accuracy (specificity, sensibility).

Conclusion

The study confirms the important correlation between malnutrition and cognitive/functional impairment and confirms that malnutrition scores could be useful in predicting depression and physical dependance in elderly dialysis patients.

Keywords

Malnutrition Dialysis Geriatric assessment Bioimpedance 

Notes

Acknowledgement

Abdulan Irina Mihaela and Onofriescu Mihai contributed equally in the research presented in this manuscript. This study has been partially supported by a Grant of Ministry of Research and Innovation, CNCS-UEFISCDI, Project Number PN-III-P4-ID-PCE-2016-0908, within PNCDI III.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.University of Medicine and Pharmacy “Gr. T. Popa” IasiIasiRomania

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