Why Do We Need to Add Objectivity to Subjective Nutrition Assessment Tools in Hemodialysis Patients

Abstract

Introduction: Malnutrition is very common in hemodialysis patients and is associated with increased morbidity and mortality. It is not clear whether subjective assessment can accurately identify status of malnutrition in dialysis patients. There is no single measure that can be utilized to provi deacomprehensive eva luationofnutritional status. Methods: Nutritional assessment was carried out using subjective and objective techniques on patients undergoing thrice a week hemodialysis. Subjective assessment was conducted using Subjective Global Assessment (SGA) and Dialysis Malnutrition Score (DMS). Objective assessment was done using handgrip strength and body composition analysis. Handgrip strength (HGS) analysis was performed using handgrip dynamometer (CAMRY, model EH101) while body composition analysis was performed using Body Composition Monitor (BCM) (Fresenius Medical Care). Sensitivity, specificity. Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were assessed. Result: Of the 91 screened patients, 81 completed the study. 81 patients of the total 91 patients, 46 were male. Their mean age was 54.8±12.7 years. Their mean albumin was 3.2±0.3 g/dl and BMI was 24.8±4.3 kg/m2. The prevalence of moderate and severe malnutrition was 69.1% and 17.2%. The sensitivity of both subjective as well as objective parameters was 86.4% while specificity of subjective parameters was 65.4% and that of objective parameters was 79%. The PPV of subjective parameters was 56.9% and that of objective parameters was 52.2%. The NPV of subjective parameters was 71.7% and that of objective parameters was 60.7%. Conclusion: Objective techniques outperform subjective techniques due to higher specificity and lower NPV. Simple, easily available bedside tools like handheld dynamometer can prove to be a good nutrition assessment technique for hemodialysis patients in combination with SGAor DMS.