Malnutrition is common in haemodialysis patients due to specific characteristics of chronic renal insufficiency such as insufficient filtration ability and accelerated protein degradation. A deteriorated nutritional condition threats chronic dialysis patients lowered mobility and poor outcome include increased mortality (Carrero et al., 2013; Locatelli et al., 2002; Vannini, Antunes, Caramori, Martin, & Barretti, 2009). Thus there are several malnutrition indicators of haemodialysis patients were proposed such as SGA, GNRI and albumin level. Nevertheless, detection rate of each indicators seems to differ to each other (Pifer et al., 2002) and consideration of particular characteristics of haemodialysis patients is required for the practical apply. Hence, use of sensitive identifying assessment method and early intervention on malnourished patients are quite meaningful.
Malnutrition and mortality in haemodialysis patients
Characteristics of haemodialysis patients are described as they have greater survive when they had a higher serum creatinine concentration or higher BMI which stand for larger body size or greater muscle mass. An increase of dry weight with muscle mass gaining correlates to the greatest survival. On the other hand, weight loss with loss of muscle mass results the worst mortality. Additionally, gain in muscle mass with weight loss was advantaged on higher survival in comparison with loss of muscle mass with weight gain (Kalantar-Zadeh et al., 2010). Mortality risk is strongly associates to a low BMI in maintenance haemodialysis patients (Kovesdy & Kalantar-Zadeh, 2009).
Mortality risk is analysed using mSGA (modified subjective global assessment) score which contains recent weight loss, visual somatic protein wasting, loss of appetite, nausea or vomiting, energy level and disease burden that to be assessed. When patients had severely malnourished mSGA scores, their mortality risk was 33 % higher, and patients in a moderate malnutrition had a 5 % higher mortality risk in compared with patients who had normal mSGA scores (Pifer et al., 2002). The other studies which assessed with BMI resulted that a decrease in BMI was associated with a 6 % greater risk of mortality, and an assessment of malnutrition by care provider was associated with a 28% higher risk of cardiovascular mortality among end stage renal disease (Fung et al., 2002), in addition, more than 3.5 % of a decline in BMI significantly increased mortality risk in haemodialysis patients (Pifer et al., 2002). These founding suggests that mortality rises when patients are in malnourished, in other words, mortality of chronic renal failure may be decreased with better nutritional status.
Protein energy wasting in haemodialysis patients
Protein energy wasting (PEW) is common among chronic kidney patients with losing muscle mass which associates a lowered mobility and an increased mortality. Renal disease patients are vulnerable to PEW, indeed, wasting is...