An assessment of malnutrition on dialysis adequacy of peritoneal dialysis patients at public nephrology facility in the Gauteng province

Abstract

Background: The physiological changes and metabolic disturbances in PD patients often lead to malnutrition, further complicating dialysis adequacy and affecting patient outcomes and quality of life. The current study aimed on the assessment of nutritional status on dialysis adequacy in PD patients, while also determining the correlation between dialysis malnutrition, dialysis adequacy and biochemical markers in PD patients. The outcome of examining this relationship contributes to clinical practice and improved outcomes for PD patients in resource-limited settings. Methods: The study included 81 patients (50 males and 31 females) undergoing peritoneal dialysis for more than three months at selected two public nephrology units in Gauteng, South Africa. The nutritional status of peritoneal dialysis patients was assessed using the Dialysis Malnutrition Score (DMS), anthropometry, dialysis adequacy (Kt/V), and biochemical indicators (serum albumin, serum urea, and serum creatinine). Results: Our findings, based on the Dialysis Malnutrition Score questionnaire, showed a large proportion of malnutrition scores: 34.57% severe, 32.10% moderate, and 14.81% mild. However, there were no correlation between dialysis adequacy and malnourishment status; this was not statistically significant, p=0.9714. Adequate dialysis (≥1.4 Kt/V) was achieved by 61.73% of patients, who were significantly younger than those who did not reach the target Kt/V of 1.4. The mean Body Mass Index was 25.56 kg/m², with 17.28% classified as obese and 2.47% as underweight, alongside notable variability in triceps skinfold thickness (median 23 mm; IQR: 18–31 mm). There was a significant correlation between dialysis adequacy and triceps skinfold (p=0.0006). The arm muscle area of our patients was also statistically significant (p<0.001), according to the Shapiro-Wilk test for normality. The median serum albumin was 34 g/L, with hypoalbuminemia common among the severely malnourished group. There was a significant correlation between dialysis adequacy and serum albumin (p=0.0057). There was no significant correlation between dialysis adequacy and Serum urea and creatinine levels. Conclusion: Our study has shown a relatively severe and moderate malnutrition among our sample population. This suggests that metrics reflecting lean body mass and somatic protein stores are strong predictors of a patient’s ability to achieve adequate PD. With this, there still remained a large group of our patients receiving adequate dialysis. Subsequently, our findings showed a significantly smaller group remained to achieve inadequate dialysis. This was related to various other reasons, such as age, anthropometrics and decreased albumin levels. The high prevalence of malnutrition, coupled with the predictive power of anthropometrics, mandates further clinical efforts to focus on improving body composition and nutritional status as an integral strategy for optimising dialysis clearance and overall patient outcomes in Gauteng PD facilities.