Subjective Global Assessment and Quality of Life in Hemodialysis Patients- A Clinical Observational Study OC13-OC17
926, 22nd Cross, 5th Main, Sector 7, HSR Layout, Bengaluru, Karnataka, India.
Introduction: Malnutrition is a prevalent problem in patients undergoing haemodialysis. Malnutrition is strongly associated with increased morbidity and mortality in these patients. Early detection and intervention is the key to prevent significant morbidity and mortality.
Aim: To assess the nutritional status of Maintenance Haemodialysis (MHD) patients by anthropometry, biochemical measurements, Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS). Also, to assess the correlation between SGA, MIS and WHO SF 36 scores which measures the Health Related Quality of Life (HRQOL).
Materials and Methods: This was a clinical observational study which included 60 stable maintenance haemodialysis patients. The patients who were on haemodialysis for atleast 3 months and who fulfilled the inclusion criteria were selected randomly and studied over a period from January 2017 to January 2019. They underwent nutritional status assessment by anthropometry i.e., Body Mass Index (BMI), Mid Arm Circumference (MAC), triceps Skin-Fold Thickness (SFT) and biochemical tests i.e., S.creatinine, S. albumin, S.cholestrol, S.total iron binding capacity (TIBC), S.ferritin, S.transferrin saturation. All the patients were subjected to SGA, MIS and SF 36 questionnaires. They were divided into 3 groups based on SGA scores: well nourished, mild to moderately malnourished and moderate to severely malnourished. Biochemical tests, anthropometric parameters, MIS scores were compared between these three groups using Analysis of variance (ANOVA) test to find out if there was any significant difference. Pearsonâ€™s correlation was performed to find the degree of correlation between SGA, MIS and WHO SF 36 scores. The p-value less than 0.05 were considered significant.
Results: In the present study, 55% were diabetics and 86.7% were hypertensive. 53.3% of the patients had a dialysis vintage of <30 months (Mean±SD: 44.33±38.52). Based on SGA scores, 20% were in well-nourished group, 63.3% of patients were in mild to moderate malnourished group and 16.7% were in moderate to severely malnourished group. Patients who were moderate to severely malnourished had significantly lesser anthropometric measurements compared to other groups. (p-value for BMI=0.001, MAC=<0.001, TSF=0.003). While studying Biochemical parameters we found that those with moderate to severe malnourishment had significantly lesser S.albumin (p-value=0.001), S.cholestrol (p-value=0.038), S.creatinine (p-value=0.005), S. transferrin (p-value=0.047) saturation. There was no significant difference with respect to S.ferritin (p-value=0.993) and TIBC (p-value=0.921). Those with moderate to severe malnourishment had higher MIS scores (p=<0.001). All quality of life aspects, physical and mental component summary and total scores (except bodily pain) had a significant difference with SGA and MIS parameters (p<0.001). All the quality of life parameters (except bodily pain) had a significant negative correlation with SGA and MIS scores. Overall (Total) SF 36 scores also had a significant negative correlation with SGA (r=-0.785) and MIS scores (r=-0.604).
Conclusion: MIS, SGA and HRQOL SF 36 are cost-effective, simple to use, bedside and readily available tools for nutritional assessment of MHD patients. Patients with poor nutrition have a poor physical and mental quality of life. Hence, it becomes important for us to identify such patients and intervene earlier, in order to improve their quality of life and also reduce morbidity which in turn helps in reducing mortality. This can be effectively carried out by using these simple and cost-effective questionnaires across all MHD units on a periodic basis to monitor their progress towards achieving better health goals.