Protein energy malnutrition in patients with chronic kidney disease in Sri Lanka

Abstract

INTRODUCTION AND OBJECTIVES: Worldwide, there is a higher prevalence of protein energy malnutrition (PEM) among patients with chronic kidney disease (CKD), compared to the general population. Biomarkers of under nutrition are associated with worse CKD outcomes and mortality. Our objectives were to determine prevalence of PEN/! in CKD patients and to assess the relationship between PEM and age, sex and CKD stage. METHOD: Adult CKD patients attending Kidney Disease Treatment and Research Centre clinics at Teaching Hospital, Anuradhapura, from 1st-31stAugust 2014 were recruited. Patients on dialysis or after renal transplantation, were excluded. CKD was defined using KDIGO guidelines. Body Mass Index (BMl), mid arm circumference (MAC), Triceps Skin-fold thickness (TSFT), most recent eGFR and knowledge about protein intake were assessed. RESULTS: 670 patients were enrolled. Average age was 58.2 years (SD 10.5 years). 634/670 (94.7%) were >40 years. 487/670 (72.7%) were men. 206/670 (30.7%) were in CKD Stage 3, 256/670 (38.2%) in Stage 4 and 153/670 (22.8%) in Stage 5. 165/670 (24.6%) had a BMI<18.5kg/m2; male sex (p<0.043) was significantly associated. 637/670 (95.1%) had a low MAC; male sex (p<0.001), age >40 years (/xO.OOl), and CKD Stage >3 (p<0.001) were significantly associated. 581/670 (86.7%) had a low TSFT; male sex (p<0.049) and CKD Stage >3 (p<0.001) were significantly associated. 359/670 (53.6%) were voluntarily restricting protein intake. 321/670 (47.9%) thought protein harmed their kidneys. CONCLUSION: A majority of CKD patients had PEM. Older men in CKD stage >3 were significantly more likely to have PEM. Since adequate nutrition is protective, assessment of nutrition parameters and correction of PEM whenever possible must be prioritised in CKD management.