Title : Evaluation of the nutritional status of elderly hemodialysis patients followed at the “La Renaissance” University Hospital Center in N’Djamena, Chad
Abstract:
Elderly patients on hemodialysis are particularly at risk of malnutrition. In addition to this specific factor, other elements contribute to the risk, necessitating a systematic evaluation of their nutritional status to improve their management and quality of life. The objective of this study was to assess the nutritional status of elderly patients undergoing hemodialysis. This was a cross-sectional, descriptive study involving 167 patients undergoing biweekly dialysis sessions, recruited from the nephrology department of CHU Renaissance in N'Djamena, Chad, over a period of 3 months. Nutritional assessment was conducted using anthropometric measurements (dry weight at the end of dialysis), biological tests, and a dietary survey. Malnutrition diagnosis was made using the Mini Nutritional Assessment (MNA) criteria. The mean age of participants was 74.27 years, with a male predominance, and the average duration of hemodialysis treatment was 7 ± 3.8 years. The mean energy intake of patients during dialysis sessions was 21.26 kcal/kg/day, compared to 15.9 ± 6.9 kcal/kg on non-dialysis days (p = 0.001). More than half of the patients (72.5%) had experienced weight loss over the 6 months prior to the study, with 51.5% losing between 5 and 10%, and 12% losing more than 10%. The mean protein intake was 0.71 ± 0.38 g/kg on dialysis days, significantly decreasing (p = 0.005) to 0.53 ± 0.28 g/kg on non-dialysis days. The mean body mass index (BMI) was 22.4 ± 9.28 kg/m², with 47.6% of patients having a BMI < 19 kg/m². Energy intake was insufficient in 91% of patients, with a notable deficit in protein intake. More than half of the patients (57%) had hypoalbuminemia (< 35 g/L). Malnutrition was present in 71% of patients, with 49% showing moderate malnutrition and 22% severe malnutrition. Additionally, 57% of moderately malnourished patients and 68.5% of severely malnourished patients met more than two MNA criteria. The results showed that 67% of patients were malnourished, 21.14% were at risk of malnutrition, and only 11.76% had satisfactory nutritional status. Furthermore, 48% of patients exhibited hypoalbuminemia, indicative of protein malnutrition. Pre-dialysis creatinine levels were abnormally low (< 900 mmol/L) in 75% of patients, suggesting malnutrition. Protein-energy malnutrition is a frequent and serious condition in elderly hemodialysis patients, significantly affecting their prognosis. Early detection is essential to reduce morbidity and mortality.
Keywords: Nutritional status, hemodialysis, chronic kidney disease, Mini Nutritional Assessment.
