SP433EVALUATION OF NUTRITIONAL STATUS IN ELDERLY HD PATIENTS: IMPACT OF THE DEGREE OF AUTONOMY AND ALIMENTARY HABITS

Abstract

Introduction and Aims: Malnutrition is a well-known mortality risk factor in dialysis patients, especially in the elderly. Periodical evaluation of nutritional status is thus of importance in this kind of patients. The study is aimed at evaluating how alimentary habits and the degree of autonomy influence the nutritional status in elderly haemodialysis patients. Methods: 76 prevalent HD patients older than 65 years (M/F 47/29, mean age 76.58 ± 6.52 years, 1/3 ≥ 80 years) underwent nutritional evaluation with anthropometric parameters and plicometry. All the patients were asked to fill the “Multidimensional Prognostic Index” (MPI) questionnaire, a new prognostic index for the elderly. Results: At anthropometric measurement 42% of the patients had a decrease in lean body mass (LBM); this was mild 5% (n=4), moderate 17% (n=13) and severe 20% (n=15), respectively. Only 26% of the patients (n=20) had a normal fat body mass (FBM), 15% (n=11), 28% (n=21) and 21% (n=16) had a mild, moderate and severe decrease in FBM. 8 patients were overweight or obese. Patients with a significant decrease in LBM, but not in FBM, were older and in both groups the interdialytic weight gain was significantly lower than in well-nourished patients. At MPI questionnaire, HD patients with moderate-severe decrease in LBM were less independent in walking or were bedridden (n=20, 71% vs. n= 21, 52%), were more likely to depend on someone else in preparing meals (n=10, 35% vs. =24, 58%) and in eating (n=7, 29% vs. n=2, 5%) compared to the well-nourished patients. Nine patients (33%) with decreased LBM had 2 meals per day (vs. n=9, 21% in well-nourished patients), had more frequently weight loss (n=11, 39% vs. n=7, 17%) and loss of appetite in the 3 previous months (n=16, 57% vs. n=18, 42%). At self-evaluation, 37% of patients with moderate-severe decrease in LBM were not aware of their nutritional problems, 22% did not know and only 40% said having a decreased nutritional status HD patients with moderate-severe decrease in FBM were less independent in eating without help (n=8, 18% vs. n=1, 4%) and in food shopping (n=25, 56% vs. n=10, 40%) compared to well-nourished patients. 33% of those with decreased FBM had a weight loss in the 3 previous months compared to only the 12% of well-nourished ones. At self-evaluation, 75% of the patients with a moderate-severe decrease in FBM were not aware of having nutritional problems or did not know; only 35% said to have problems. Conclusions: An important percentage of elderly HD patients show a significant decrease in either LBM or FBM. The decrease in FBM seems to happen earlier than LBM reduction and it is less influenced by the degree of autonomy of the patients. The patient's awareness of his own nutritional status is poor.