Factors Affecting Malnutrition in Hemodialysis Patients

Ok Lae Park; Young Jun Jang; Jong Hwan Jung; Sung Reul Kim

doi:10.7469/kjan.2016.28.2.226

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Park, Jang, Jung, and Kim: Factors Affecting Malnutrition in Hemodialysis Patients

Original Article

Korean J Adult Nurs 2016;28(2):226-236.

Published online: April 2016

DOI: https://doi.org/10.7469/kjan.2016.28.2.226

Factors Affecting Malnutrition in Hemodialysis Patients

Ok Lae Park¹, Young Jun Jang², Jong Hwan Jung³, Sung Reul Kim⁴

^¹Department of Nursing, Wonkwang University Hospital, Iksan

^²Department of Nursing, Chonbuk National University Hospital, Jeonju

^³Division of Nephrology, Department of Internal Medicine, Wonkwang University Hospital, Iksan

^⁴College of Nursing · Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea

Corresponding author: Kim, Sung Reul College of Nursing, Chonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54899, Korea. Tel: +82-63-270-3118, Fax: +82-63-270-3127, E-mail: srkim@jbnu.ac.kr

Received 2 March 201617 April 2016 Accepted 18 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to evaluate the nutritional status and to identify factors affecting malnutrition in hemodialysis patients.

Methods

Data were collected from a convenience sample of 125 hemodialysis patients who agreed to participate in the study, between August 1 and October 4, 2014. Five structured questionnaires were used: Patient-generated Subjective Global Assessment, Simplified Nutritional Appetite Questionnaire, Self-rating Depression Scale, Fatigue Scale, and Family Support Scale. Data were analyzed by descriptive statistics, t-test, Mann-Whitney U test, x²-test, and stepwise multiple regression analysis by using SPSS/WIN 22.0 program.

Results

Of 125 patients, 30.4% were found to be malnourished. Malnutrition was related to age, family household income, depression, fatigue, social support, appetite, and levels of C-reactive protein and serum albumin. Stepwise multiple regression analysis showed that appetite, C-reactive protein level, fatigue, and albumin level were significant factors affecting malnutrition in hemodialysis patients.

Conclusion

Regular and consistent nutritional assessment is essential in hemodialysis patients. Nurses who care for hemodialysis patients need to consider the factors identified from these findings when assessing their patients’ nutritional status and needs.

Keywords: Appetite, Fatigue, Hemodialysis, Malnutrition

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Table 1.

Demographic, Disease Related and Nutritional Characteristics in Hemodialysis Patients (N=125)

Variables	Categories	n (%) or M±SD	Range
Gender	Male	66 (52.8)
Gender	Female	59 (47.2)
Age (year)		58.61±13.28	28~83
Marital status	Married	76 (60.8)
	Single	13 (10.4)
	Divorced	12 (9.6)
	Widowed	23 (18.4)
	Others	1 (0.8)
Family income (10,000 won/month)	＜100	87 (69.6)
	100~200	24 (19.2)
	＞200	14 (11.2)
HD number (time/week)	2	33 (26.4)
HD number (time/week)	3	92 (73.6)
HD duration (year)		3.89±4.33	0.7~20
Origin disease	Diabetes mellitus	63 (50.4)
	Hypertension	30 (24.0)
	Glomerulonephritis	9 (7.2)
	Polycystic kidney diseases	3 (2.4)
	SLE	2 (1.6)
	Others	18 (14.4)
Origin disease duration (year)		16.80±8.80	1~40
BUN (mg/dL)	70.77±22.47	23.3~150.0
URR (%)	69.00±5.58	52.0~84.0
Kt/V	1.41±0.23	0.8~2.2
Body weight (kg)	59.16±9.97	39~93
BMI (kg/m²)	22.18±3.03	16.8~32.0
	＜18.5	10 (8.0)
	18.5~24.9	99 (79.2)
	≥25	16 (12.8)
Hemoglobin (g/dL)		9.98±1.34	6.2~14.0
CRP (mg/L)	8.91±29.15	0.3~258.6
Albumin (g/dL)	3.66±0.41	2.0~4.7

HD=hemodialysis; BUN=blood urea nitrogen; URR=urea reduction ratio; KT/V=urea clearance rate/volume; BMI=body mass index; CRP=C-reactive protein; SLE=systemic lupus erythematosus.

Table 2.

Nutritional Status, Appetite, Fatigue, Depression, and Family Support in Hemodialysis Patients (N=125)

Variables	n (%) or M±SD	Range
Nutritional status Non-malnutrition (PG-SGA＜9)	6.52±4.35	1~24
Malnutrition (PG-SGA≥9)	38 (30.4)
Non-malnutrition (PG-SGA＜9)	87 (69.6)
Appetite	13.42±3.05	5~21
Fatigue	91.02±27.40	28~152
Depression	49.14±10.09	24~74
Family support	35.86±8.92	10~50

PG-SGA=patient-generated subjective global assessment.

Table 3.

Comparison of Demographic, Disease Related, and Nutritional Characteristics between Non-malnutrition Group and Malnutrition Group (N=125)

Variables	Categories	Non-malnutrition (PG-SGA＜9) (n=87)	Malnutrition (PG-SGA≥9) (n=38)	x² or z or t	p
		n (%) or M±SD	n (%) or M±SD
Gender	Male	51 (58.6)	15 (39.5)	3.89	.051
Gender	Female	36 (41.4)	23 (60.5)
Age (year)		57.29±13.33	61.63±12.82	-1.70	.093
Marital status	Married	56 (64.4)	20 (52.6)	1.25	.324
Marital status	Not-married	31 (35.6)	18 (47.4)
Family income (10,000 won/month)	＜100	54 (62.1)	33 (86.8)	9.49	.009
	100~200	19 (21.8)	5 (13.1)
	＞200	14 (16.1)	0 (0.0)
HD number (time/week)	2	21 (24.1)	12 (31.6)	0.75	.385
HD number (time/week)	3	66 (75.9)	26 (68.4)
HD duration (year)		4.09±4.74	3.44±3.19	-0.24	.807^†
Origin disease	Diabetes mellitus	39 (44.8)	24 (63.2)	6.89	.234
	Hypertension	21 (24.1)	9 (23.7)
	Glomerulonephritis	7 (8.0)	2 (5.3)
	PKD	3 (3.4)	0 (0.0)
	SLE	1 (1.1)	1 (2.6)
	Others	16 (18.4)	2 (5.3)
Origin disease duration (year)		16.18±8.84	18.21±8.68	-0.83	.407^†
BUN (mg/dL)		72.91±21.13	65.89±24.90	1.62	.109
URR (%)		68.65±5.25	69.82±6.27	-1.08	.284
KT/V		1.39±0.20	1.46±0.30	-0.93	.354^†
Body weight (kg)		59.58±11.11	56.88±10.80	1.26	.211
BMI (kg/m²)		22.17±2.74	22.20±3.65	-0.84	.401^†
Hemoglobin (g/dL)		10.17±1.25	9.55±1.46	2.42	.170
CRP (mg/L)		3.73±7.46	20.78±50.10	-1.97	.049^†
	0~5	74 (85.1)	25 (71.4)	3.03	.123
	＞5	13 (14.9)	10 (28.6)
Albumin (g/dL)		3.72±0.34	3.54±0.51	-2.08	.037^†
Appetite		14.39±2.68	11.18±2.67	6.15	＜.001
Fatigue		83.26±25.85	108.79±22.32	-5.29	＜.001
Depression		45.75±8.97	56.92±8.05	-6.60	＜.001
Family support		37.37±8.48	32.42±9.05	2.94	.004

PG-SGA=patient-generated subjective global assessment; HD=hemodialysis; BUN=blood urea nitrogen; URR=urea reduction ratio; KT/V=urea clearance rate/volume; BMI=body mass index; CRP=C-reactive protein; PKD=polycystic kidney disease; SLE=systemic lupus erythematosis;

^† Mann-Whitney U test.

Table 4.

Correlation Coefficients among the Variables (N=125)

Variables	X1	X2	X3	X4	X5	X6	X7	X8	X9	X10
X2	-.14^†
	(.205)
X3	-.19	-.04^†
	(.032)	(.644)
X4	.01^†	-.15^†	.09^†
	(.943)	(.094)	(.302)
X5	-.04	-.03^†	-.02	.13^†
	(.652)	(.710)	(.807)	(.158)
X6	.14^†	.02^†	-.14^†	.02^†	-.20^†
	(.112)	(.821)	(.132)	(.798)	(.026)
X7	-.33^†	.28^†	.08^†	-.03^†	.16^†	-.39^†
	(＜.001)	(.001)	(.368)	(.778)	(.073)	(＜.001)
X8	.21	-.04^†	-.63	-.04^†	-.09	.21^†	-.05^†
	(.018)	(.629)	(＜.001)	(.635)	(.311)	(.017)	(.593)
X9	.31	-.01^†	-.48	-.05^†	-.14	.18^†	-.17^†	.73
	(.001)	(.972)	(＜.001)	(.579)	(.108)	(.048)	(.059)	(＜.001)
X10	-.11	-.13^†	.16	.01^†	.22	-.07^†	.11^†	-.31	-.30
	(.208)	(.152)	(.082)	(.979)	(.012)	(.420)	(.222)	(＜.001)	(.001)
X11	.25	-.06^†	-.65	-.06^†	-.17	.29^†	-.36^†	.61	.60	-.21
	(.005)	(.521)	(＜.001)	(.562)	(.058)	(.001)	(＜.001)	(＜.001)	(＜.001)	(.019)

X1=age; X2=duration of hemodialysis; X3=appetite; X4=body mass index; X5=hemoglobin; X6=C-reactive protein; X7=albumin; X8=depression; X9=fatigue; X10=family support; X11=patient-generated subjective global assessment;

^† Spearman correlation.

Table 5.

Factors Affecting Malnutrition in Hemodialysis Patients by Stepwise Multiple Regression (N=125)

Variables	B	SE	β	t	p	Adj. R²	F	p
(Constant)	16.693	3.193		5.229	＜.001		51.425	＜.001
Appetite	-0.678	0.090	-.476	-7.544	＜.001	.418
CRP	0.033	0.009	.221	3.473	.001	.523
Fatigue	0.050	0.010	.318	4.986	＜.001	.604
Albumin	-1.630	0.673	-.154	-2.422	.017	.619

CRP=C-reactive protein.

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