Introduction: Undernutrition is common in haemodialysed diabetic patients. To estimate the nutritional status before and after dialysis, we followed up prospectively initially undialysed uremic diabetic patients.
Methods: All 20 patients had initial body composition (Lean Body Mass, LBM, using DEXA) and serum albumin (SA) measurements. Ten patients underwent hemodialysis (HD) after 15 m (mean). They had a similar LBM & SA evaluation 6.5 m after starting dialysis. The 10 other patients with end stage renal disease (ESRD, glomerular filtration rate, GFR <30 ml/min/1.73 m2 using 51Cr-EDTA) but not HD had a second evaluation after 24 m. The results (means±sem) were compared within and between groups (paired and unpaired Students t test, respectively).
Results: Initially, no difference was found between HD and ESRD patients. Clinically, the initial characteristics of patients were: age 61.6±10.3 vs 65.6±9.6 yr, sex 7 vs 5 men, 80% vs 80% type 2 diabetes. Biologically, we found GFR 16.2±5.3 vs 19.7±6.2 ml/min/1.73 m2, weight 73.9±16.8 vs 73.7±12.5 kg, LBM 49.9±10.4 vs 51.2±11.1 kg and SA 34.4±3.2 vs 36.6±2.4 g/l in HD and ESRD respectively.
At the second time point, for HD patients, total body weight tended to decrease −3.4±6.2 kg (P>0.05 within group & compared to ESRD) due to a significant loss of LBM −4.2±5.7 kg (P=0.046 within group; P>0.05 compared to ESRD) associated to a maintained SA level +0.3±1.1 g/l (P>0.05 within group; P=0.039 compared to ESRD). Conversely for ESRD patients (GFR +1.7±8.9 ml/min/1.73 m2), total body weight +0.3±6.0 kg, LBM +1.6±2.8 kg were unchanged and SA levels significantly improved +3.2±1.4 g/l (P=0.01).
Conclusion: The nutritional status of HD patients altered compared to the status of ESRD patients. Whether this is due to initiating haemodialysis therapy remains to be investigated. Alternatively, it may be due to the diseases evolution per se. In any case, adapted nutritional advice should be provided at this period.
01 - 05 Apr 2006
European Society of Endocrinology