Association of Dialysis Malnutrition Score with Hypoglycemia and Quality of Life among Patients with Diabetes on Maintenance Hemodialysis
Keywords:malnutrition, Dialysis Malnutrition Score, hypoglycemia, quality of life, dialysis
Abstract*Visual Abstracts prepared by Dr. Raoul Roy Felipe
Objective. To determine the association between Dialysis Malnutrition Score (DMS), hypoglycemia and quality of life among patients with Diabetes on Maintenance Hemodialysis (MHD).
Methodology. Ninety-two diabetic patients on maintenance hemodialysis were assessed using a standardized data collection tool, Dialysis Malnutrition Score, WHOQoL-BREF questionnaire, anthropometric measurements and hourly blood sugar monitoring during the dialysis session. Association among DMS, hypoglycemia and quality of life were assessed along with other associated variables.
Results. Based on the DMS, 62% of patients were malnourished. Those with malnutrition were significantly older (p=0.0006) and female (p=0.013). Only 6.5% of the participants developed hypoglycemia during dialysis. Those with poor nourishment in the DMS showed a significant trend of decrease in the quality of life (physical (p<0.001), psychological (p<0.001) and social (p=0.004) and is associated with the occurrence of hypoglycemia (p<0.001).
Conclusion. Malnutrition is prevalent in diabetic patients on MHD using DMS. A higher DMS score is highly correlated with increased risk of hypoglycemia and decreased quality of life hence detection of malnutrition is important to prevent further nutritional depletion, hypoglycemia and poor patient outcomes by implementing preventive measures such as nutritional counselling and psychosocial interventions.
International Diabetes Federation, Diabetes Atlas, 8th edition, 2017.
Gheith O, Farouk N, Nampoory N, et al. Diabetic kidney disease: Worldwide difference of prevalence and risk factors. J Nephropharmacol. 2016;5(1):49-56. PMID: 28197499. PMCID: PMC5297507.
Toth-Manikowski S, Atta MG. Diabetic kidney disease: Pathophysiology and therapeutic targets. J Diabetes Res V. 2015;2015:Article ID 697010. https://doi.org/10.1155/2015/697010.
Ghaderian SB, Hayati F, Shayanpour S, Beladi Mousavi SS. Diabetes and end-stage renal disease; A review article on new concepts. J Renal Inj Prev. 2015;4(2):28-33. PMID: 26060834. PMCID: PMC4459725. https://doi.org/10.12861/jrip.2015.07.
Ikizler T. Optimal nutrition in hemodialysis patients. Adv Chronic Kidney Dis. 2013; 20(2):181-9. PMID: 23439378. PMCID: PMC3582995. https://doi.org/10.1053/j.ackd.2012.12.002.
Kalantar-Zadeh K, Kleiner M, Dunne E, Lee GH, Luft FC. A modified quantitative subjective global assessment of nutrition for dialysis patients. Nephrol Dial Transplant 1999;14(7):1732-8. PMID: 10435884.
Divina RJ, Felicida FS, Chan RE, Llido LO. Nutritional status of hemodialysis patients in the Philippines: A cross-sectional survey in four out-patient dialysis centers. PhilsPEN. 2010;82-9.
Czira M, Lindner AV, Szeifert L, et al. Association between the malnutrition-inflammation score and depressive symptoms in kidney transplanted patients. Gen Hosp Psychiatry. 2011;33(2):157-65. PMID: 21596209. https://doi.org/10.1016/j.genhosppsych.2011.01.012.
Ebrahimzadehkor B, Dorri A, Yapan-Gharavi A. Malnutrition-inflammation score in hemodialysis patients. Zahedan J Res Med Sci. 2014;16(8):25-8.
Afshar R, Sanavi S, Izadi-Khah A. Assessment of nutritional status in patients undergoing maintenance hemodialysis: A single-center study from Iran. Saudi J Kidney Dis Transpl.2007;18(3):397-404. PMID: 17679753.
Sohrabi Z, Eftekhari MH, Eskandari MH, Rezaeianzadeh A, Sagheb MM . Malnutrition-inflammation score and quality of life in hemodialysis patients: Is there any correlation? Nephrourol Mon. 2015;7(3):e27445. PMID: 26034747. PMCID: PMC4450166. https://doi.org/10.5812/numonthly.7(3)2015.27445.
Boado JRV, Redondo DC, Flauta-Orio J, et al. Nutrition assessment of patients on maintenance hemodialysis using dialysis malnutrition score (DMS). PhilSPEN 2014;74-88.
Yamada K, Furuya R, Takita T, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr. 2008;87(1):106-13. PMID: 18175743. https://doi.org/10.1093/ajcn/87.1.106.
Harvinder GS, Swee WC, Karupaiah T, et al. Dialysis malnutrition and malnutrition inflammation scores: Screening tool for prediction of dialysis related protein-energy wasting in Malaysia. Asia Pac J Clin Nutr 2016;25(1):26-33. PMID: 26965758.
As’habi A, Tabibi H, Nozary-Heshmati B, Mahdavi-Mazdeh M, Hedayati M. Comparison of various scoring methods for the diagnosis of protein-energy wasting in hemodialysis patients. Int Urol Nephrol. 2014;46:999-1004.
Lim S, Lin XH, Daniels L. Seven-point subjective global assessment is more time sensitive than conventional subjective global assessment in detecting nutrition changes. JPEN J Parenter Enteral Nutr. 2016;40(7):966-72. PMID: 25847315. https://doi.org/10.1177/0148607115579938.
Campbell KL, Ash S, Bauer J, Bauer J, Davies PSW. Critical review of nutrition assessment tools to measure malnutrition in chronic kidney disease. Nutrition and Dietetics. 2007;64(1):22-30. https://doi.org/10.1111/j.1747-0080.2007.00116.x.
Jahromi SR, Hosseini S, Razeghi E, Meysamie Ap, Sadrzadeh H. Malnutrition predicting factors in hemodialysis patients. Saudi J Kidney Dis Transpl. 2010;21(5):846-51. PMID: 20814118.
Miguel LS, Julia ÁH, Mercè P, et al. Prevalence of hospital malnutrition in patients with diabetes mellitus: A sub-analysis of the PREDyCES study. SM J Public Health Epidemiol. 2015;1(4):1018.
Hickson M. Malnutrition and ageing. Postgrad Med J. 2006;82(963):2-8. PMID: 16397072. PMCID: PMC2563720. https://doi.org/10.1136/pgmj.2005.037564.
Rambod M, Bross R, Zitterkoph J, et al. Association of malnutrition-inflammation score with quality of life and mortality in hemodialysis patients: A 5-year prospective cohort study. Am J Kidney Dis. 2009; 53(2):298-309. PMID: 19070949.PMCID: PMC5500250. NIHMSID: NIHMS322402.
Bilgic A, Akgul A, Sezer S, Arat et al. Nutritional status and depression, sleep disorder and quality of life in hemodialysis patients. J Ren Nutr 2007;17(6):381-8. PMID: 17971310. https://doi.org/10.1053/j.jrn.2007.08.008.
Spiegel BMR, Melmed G, Robbins S, Esrailian E. Biomarkers and health-related quality of life in end-stage renal disease: A systematic review. Clin J Am Soc Neohrol. 2008; 3(6):1759-68. PMID: 18832106. PMCID: PMC2572281.
Yusop NBM, Mun CY, Shariff ZM, Huat CH. Factors associated with quality of life among hemodialysis patients in Malaysia. PLoS ONE. 2013;8(12):e84152. https://doi.org/10/1371/journal.pone.0084152.
Sathvik BS, Parthasarathi G, Narahari MG, Gurudev KC. An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire. Indian J Nephrol. 2008;18(4):141-9. PMID: 20142925. PMCID: PMC2813538. https://doi.org/10.4103/0971-4065.45288.
Chu YW, Lin HM, Wang JJ, Weng SF, Lin CC, Chien CC. Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study. PLoS One. 2017;12(3):e0174601. PMID: 28355264. PMCID: PMC5371333. https://doi.org/10.1371/journal.pone.0174601.
Cho A, Noh JW, Kim JK, et al. Prevalence and prognosis of hypoglycaemia in patients receiving maintenance dialysis. https://doi.org/10.1002/imj.13230.
Abdelhafiz A, Rodriguez-Mañas L, Morley JE, Sinclair A. hypoglycemia in older people- a less well recognized risk factor for frailty. Aging Dis. 2015;6(2):156-67. PMID: 25821643. PMCID: PMC4365959. https://doi.org/10.14336/AD.2014.0330.
Jung HS, Kim HI, Kim MJ, et al. Analysis of hemodialysis-associated hypoglycemia in patients with type 2 diabetes using a continuous glucose monitoring system. Diabetes Tech Ther. 2010;12(10):801-7. PMID: 20809681. https://doi.org/10.1089/dia.2010.0067.
Abe M, Kalantar-Zadeh K. Hemodialysis-induced hypoglycemia and glycemic disarrays. Nat Rev Nephrol. 2015;11(5):302-12. PMID: 25848881. PMCID: PMC6015632. https://doi.org/10.1038/nrneph.2015.38.
Sun CY, Lee CC, Wu MS. Hypoglycemia in diabetic patients undergoing chronic hemodialysis. Ther Apher Dial. 2009;13(2):95-102. PMID: 19379147. https://doi.org/10.1111/j.1744-9987.2009.00662.x.
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