Effect of nutritional status on the incidence of anemia in hemodialysis patients

Abstract

Background: Anemia is a frequent complication among patients with end-stage renal disease receiving hemodialysis (HD). It increases morbidity and mortality and markedly impairs quality of life. Suboptimal nutritional status may exacerbate anemia by impairing erythropoiesis and attenuating response to erythropoiesis-stimulating agent (ESA) therapy.Objectives: To examine the association between nutritional status and anemia severity in patients undergoing maintenance HD.Methods: We conducted an observational analytic study with a cross-sectional design at the Hemodialysis Unit of Teaching Hospital Malang. Using total sampling, 177 eligible patients (HD ≥6 months, hemoglobin <10 g/dL, receiving uniform ESA therapy) were enrolled. Hemoglobin values were obtained from medical records. Nutritional status was assessed using the Dialysis Malnutrition Score (DMS). Associations between nutritional status and anemia severity were analyzed with logistic regression (two-tailed α = 0.05).Results: Overall, 43.5% of patients had severe malnutrition and 37.9% had severe anemia. Nutritional status was significantly associated with anemia severity (p < 0.001), with a model pseudo-R² of 0.312, indicating moderate explanatory power.Conclusions: Poorer nutritional status is significantly associated with greater anemia severity in maintenance HD patients. Comprehensive anemia management should incorporate routine nutritional assessment (e.g., DMS) and targeted nutrition interventions alongside standard anemia therapies to improve outcomes.