Protein-Energy Wasting And Survival In Diabetes Mellitus Hemodialysis Patients

Protein-energy malnutrition (PEW) is a frequent complication in patients with end-stage renal disease (ESRD) and is well known to be associated with cardiac codities, inflammation and a prediction of poor survival in dialysis patients. The study aimed to evaluate and follow up nutritional status in diabetic vs. nondiabetic patients undergoing maintenance hemodialysis (HD) and to see its influence on survival rates. A number of 137 patients (42% female, 56.5% with DM, mean age 56 +/- 13 yrs) on chronic hemodialysis from two dialysis centers in Bucharest have been enrolled in a descriptive longitudinal study. Anthropometric parameters, biological, markers, body composition and handgrip strength (performed using a hydraulic hand dynamometer) were measured. Followup was performed at 12 and 24 month intervals from the initial evaluation. The initial evaluation showed a statistically significant (p<0.001) higher prevalence of PEW syndrome in diabetic vs. non-diabetic HD patients. Mean adipose tissue mass was higher and mean muscular mass was lower in the DM patients group. In patients with DM undergoing HD, HGS was lower; there was an inverse relationship between HGS and DM duration and a direct relationship between HGS and inflammatory biomarkers. The assessments performed at 12 and 24 months showed similar evolution in both groups, with a statistical significant decrease in muscular mass in diabetic patients. In the Kaplan Meier survival analysis, mortality rate was 60% in patients with decreased HGS versus 12% in patients with normal HGS (p=0.028). PCW is more frequent in diabetic patients, which also associate an increase in body fat. Periodical nutritional assessment is necessary because of its permanent variations, mainly in patients with DM. Markers of PEW correlate with mortality so nutritional status must be evaluated in order to individualize treatment and prevent complications.