Investigating the nutritional status of hemodialysis patients and factors related to it in Razi Medical Training Center, Rasht 2013

Dissertation

To receive a nursing master's degree

(special care orientation)

Abstract

Introduction: Malnutrition is a nutritional disorder caused by a decrease or imbalance in energy, protein, vitamin and mineral intake. Among the patients who have a high prevalence of protein-energy malnutrition among them are those suffering from the final stages of kidney disease. Despite many researches related to the prevalence of malnutrition among chronic renal failure patients undergoing hemodialysis, few of them have screened and quickly identified malnutrition patients and related factors.

Objective: The purpose of this study is to determine the nutritional status of hemodialysis patients and factors related to it.

Materials and methods: In this cross-sectional study, 312 patients with chronic renal failure undergoing hemodialysis referred to Razi Medical Education Center were selected by census method and examined using a two-part instrument including a questionnaire related to nutritional status and a comprehensive subjective scale with dialysis-malnutrition score (SGA-DMS). The data were collected through interviews with patients, examination and review of their medical records and were analyzed using descriptive statistics (prevalence, mean and standard deviation) and inferential statistics (generalized linear models) considering the significance level (P<0.05) in SPSS version 16.

Results: The results of this study show that the nutritional status of the majority (65.1%) of the research units based on Comprehensive subjective assessment was mild to moderate malnutrition. Also, the examination of factors related to the nutritional status of hemodialysis patients showed a statistically significant relationship between the SGA tool score and age, education, marital status, living status, number of family members, and employment (P=0.000). Discussion and conclusion: According to the results of this research, the need to pay more attention to the nutritional status of hemodialysis patients and screening to quickly identify malnourished patients and take appropriate action through controlling related factors is highlighted.

Keywords: kidney dialysis, nutritional status, nutritional assessment.

       Statement of the problem

Getting sick is one of the most important obstacles to health, which by changing the body's vital functions leads to a person's distance from the health status (1). Among the diseases, chronic diseases, which have an increasing prevalence in the world due to the expansion of treatment methods and the reduction of disease attenuation, with a long process necessarily make patients need care, guardianship and rehabilitation (2). Chronic diseases are the biggest problem of the health care system and they occur in every age group, economic, social and cultural level (3). Today, chronic diseases are the main cause of health problems in developed countries (4).

Chronic kidney disease (CKD)[1] is also among chronic diseases, among the major problems that affect most body systems due to uremia caused by the disease (5). The increasing prevalence of this disease is a proof of its importance in the health of society. According to statistics, this disease has affected 16.8% of the population aged 20 years and older in the United States of America (6) and it is predicted that we will see a 44% increase in the prevalence of this disease in all age groups by 2015 worldwide (7). According to available reports, the prevalence of this disease in 2013 in Iran was 400 thousand people (8). Gilan province is also facing an increasing number of kidney patients. In 2013, the number of people was announced as 3000 (9).

Recent advances in medical science and the possibility of kidney transplant have opened a window of hope for these patients.  The experiences gained in this short time have increased our knowledge and awareness day by day about the problems of this group of patients and the factors affecting their mortality. But all these patients are not able to receive a transplant (5).Therefore, many need to use dialysis to save their lives due to the conditions prohibiting the use of kidney transplant, the requirement to wait for the transplant, and due to the rejection of the transplant performed (6). For this reason, today about 90% of patients with this disease are treated with hemodialysis(10).

Gilan province is also facing an increasing trend of patients undergoing hemodialysis. According to the statistics compiled by the researcher, the number of hemodialysis patients in Gilan province has increased from 502 patients in 1385 to 807 patients (with an increase of 60 percent) in 1390 and 924 patients in 1391. Hemodialysis for the first time in the beginning of the year 1945 was used for end-stage renal disease (ESRD) patients [2] due to its important role in increasing the life expectancy of these patients (30). Today, hemodialysis is usually performed 3 sessions a week for 3-4 hours in each session (26).

It is important to note that hemodialysis is not able to cure the disease and compensate all the metabolic or endocrine functions of the kidney, and it can only reduce the incidence and severity of some symptoms of the disease and prevent the death of those suffering from chronic kidney disease. Therefore, patients undergoing dialysis treatment experience special problems permanently due to the impossibility of excreting all toxic products and the continued disruption of the internal functions of the kidneys. In addition to the complications of kidney failure, these patients will also experience specific complications related to dialysis, which are acute (such as hypotension, muscle cramps, imbalance syndrome, nausea and vomiting, headache, chest pain, itching, allergic reactions, etc.) and chronic (such as osteoporosis, viral hepatitis B and C, AIDS, sepsis, etc.). In addition, most patients will suffer from problems such as poor nutritional status and low quality of life due to the need for long-term hemodialysis at the usual frequency of 3 times a week. Protein-energy malnutrition is common among hemodialysis patients and is considered one of the most important factors of cardiovascular disease in hemodialysis patients (11). Therefore, nutritional assessment of patients is necessary to identify the nutritional needs of different body tissues and supply them. Of course, in situations where the patient is unable to swallow or does not have a proper level of consciousness (such as patients who are hospitalized in the intensive care unit) or because of nausea or anorexia, they do not want to eat (such as cancer patients), nutritional interventions are carried out in an intestinal or intravenous way. In hemodialysis patients, nutrition has a major impact on the treatment process and their fate, and for these patients, creating suitable nutritional conditions, preventing malnutrition or correcting it, is one of the main nutritional goals. In fact, nutritional assessment is very effective for improving the quality of life, promoting health and reducing the problems and complications of diseases, reducing hospitalization time and reducing treatment costs (5, 11 and 13). Malnutrition is an internal syndrome that requires oral and intravenous nutritional support. Deficiency of vitamins in this case can be diagnosed by taking the history and physical examination of the patients. Clinical signs and symptoms of malnutrition are determined by serum albumin less than 3 g/dl and transferrin level below 200 mg/dl. In most of the affected patients, not only the intake of calories is less than the nutritional needs, but it is also associated with a state of hypercatabolism. Because in the field of trauma, fever, septicemia and wound healing, the daily caloric requirement increases. About 150-200 kcal of energy is required to maintain the basic daily requirement. An increase in body temperature by one degree Celsius increases the basic energy requirement by 15%, multiple fractures by 25%, burns and large tumors by 100%. After surgery, proteins are broken and protein synthesis decreases. Therefore, in malnutrition, there is a disturbance in the composition of the body, provided that the entry of nutrients into the body is less than the required level. As a result of the function of body organs, there is a decrease and chemical disturbance in blood tests and a decrease in body mass (12).

In malnutrition caused by simple fasting or low food consumption, loss of fats and proteins occurs.