Relationship between nutritional parameters and physical independence in local Chinese patients undergoing haemodialysis

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Relationship between nutritional parameters and physical independence in local Chinese patients undergoing haemodialysis


Author: Chan, Choi-lin
Title: Relationship between nutritional parameters and physical independence in local Chinese patients undergoing haemodialysis
Year: 2005
Subject: Hong Kong Polytechnic University -- Dissertations
Chronic renal failure -- Patients -- Nutrition
Chronic renal failure -- Patients -- Physiology
Department: School of Nursing
Pages: v, 76, 10, 13 leaves ; 30 cm
Language: English
Abstract: Background: Protein-energy malnutrition (PEM) is a common health issue encountered by patients afflicted with End Stage Renal Disease (ESRD). Poor nutrition in dialysis patients is associated with increased morbidity and mortality in form of delayed wound healing, malaise, fatigue, increased susceptibility to infection and poor rehabilitation. Although related studies in patients receiving haemodialysis (HD) had been documented in western countries, there are few published study to address similar issue on Chinese HD population. Moreover, the nutritional status in HD patients may give rise a different picture that depends on what kind of measurement the researcher used. Cautions may need to take in interpreting the result. One of the possible reasons is that there is no single measure provides a more comprehensive overview of nutritional status. A more accurate, concise views on PEM should include the collective evaluation of multiple parameters. The challenge for the health care workers (HCW) acts like a gatekeeper to detect the possibility of PEM in a more effective and comprehensive way because each nutritional marker has its own predictability and accuracy. With better understanding of patients in terms of PEM, HCWs can be more proactive in formulating care to improve the clinical outcomes of dialysis population, e.g. maximizing functioning and enhancing well being. Objectives: To evaluate the nutritional status of older ( >=65 years ), middle age ( 50-64 years ) and younger (<50 years ) maintenance haemodialysis patients recruited in present study, and to examine the relationship between age, nutritional status, comorbidity and physical independence level. Design: A cross-sectional analysis of the 64 subjects in baseline was performed in a single center. Independent variables (predictor): The nutritional status was assessed in three categories in this analysis: 1) Biochemical measurement: serum albumin level (Sr. albumin) & normalized protein catabolic rate (nPCR); 2) Physical measurement: body mass index (BMI); 3) Anthropometric measurement: triceps skin-fold thickness (TSF), mid-arm circumference (MAC) & mid-arm muscle circumference (MAMC). Comorbidity was measured by using the Index of Coexistance Disease (ICED). Main outcome measures: Barthel Index was used to measure subjects' physical independence level. Results: Serum albumin level was the most significant predictor among the various types of nutritional parameters associated with physical independence level. About 68.8% of overall subjects below the standard of DOQI guidelines of serum albumin level. In details, the younger, middle- & the old-aged group contributed 64.0%,73.3% & 66.7% within its age-group as below the standard respectively. In general, older-aged subjects had a lower mean serum albumin, BMI, MAC & MAMC, more comorbidities & lower physical independence level than the middle-& younger aged subjects. Conclusion: Older subjects may be at greater risk for developing PEM than younger subjects. Lower levels of nutritional status, advanced age & higher comorbidities were associated with lower level physical independence level in subjects with ESRD.

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