الفهرس 
Protein Energy MalnutritionOnly 14 pages are availabe for public view
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Abstract
Management of renal anemia seems to be of great importance in ensuring a better quality of life for end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) treatment.
Several studies have shown that anemia is highly prevalent in ESRD patients. Thirty four to sixty seven percent of patients starting renal replacement therapy (RRT) exhibited signs of anemia, and lower hematocrit values which are commonly associated with a higher hospitalization rate.
Over the last 15 years, the availability of EPO has led to the almost complete disappearance of severe anaemia requiring blood transfusions in patients with CKD.
It was believed that iron deficiency was the major predictor of EPO hyporesponsiveness, however, many dialysis patients, despite adequate iron supplementation, still require inappropriately higher doses of EPO.
Refractory anemia appears to be common as well in those dialysis patients who also suffer from PEM or inflammation.
A large proportion of CKD patients also have PEM and wasting, low serum levels of albumin and other more specific nutritional markers which are predictors of the response to EPO.
Some studies have reported that high body fat mass estimated by BMI (>25 kg/m2) is associated with a reduced all-cause and cardiovascular (CV) morbidity and mortality in HD patients (‘obesity paradox’). It would indicate that fat mass rather than lean mass plays a protective role against morbidity and mortality in HD patients.
Because inflammation and PEM have a high prevalence and are found to be closely related to each other in dialysis patients, together they are also referred to as malnutrition-inflammation complex syndrome (MICS).
Studies found that MIS is a reliable measure of the degree of severity of MICS and has a significant association with EPO hyporesponsiveness.
The aim of the study is to determine the effect of malnutrition-inflammation complex on the erythropoietin response in maintenance hemodialysis patients.
The present study included 78 patients receiving regular haemodialysis in Ain Shams University hospitals dialysis units.
All patients were subjected to full history, detailed physical examinations, Routine laboratory investigations ( Hgb level , serum creatinine, BUN, Na+, K+, Ca+2, PO4-, albumin) at the start of the study and follow up every month , PTH level at the start and at the end of the study and highly sensitive CRP level and iron profile.
Also Malnutrition inflammation score (Kalantar-Zadeh et al ; 2001) was measured for all patients and they were grouped accordingly into 3 groups normal nutrition (score: 0–5) , mild malnutrition (6 –10) , and moderate to severe malnutrition (≥11).
Our study showed that mean age of patients increases with increasing degree of MIA syndrome with highly significant statistical difference between the 3 groups.
Also BMI showed significant inverse correlation with the degree of MIA syndrome.
There was no significant statistical difference between degree of MIA syndrome and gender , body weight , etiology of ESRD , dialysis duration and type of vascular access. Also BUN , serum creatinine , Na+ , K+, Ca+2 , PO4 , PTH , CRP , serum Iron and baseline Hgb had statistically insignificant difference between the 3 groups of MIA syndrome.
There was a significant inverse correlation between natural logarithm of weekly EPO dose and baseline Hgb level.
There was also a significant inverse correlation between natural logarithm of weekly EPO dose and transferring saturation.
MIA score , IV iron per month and duration of ESRD all showed significant positive correlation with natural logarithm of weekly EPO dose.
In conclusion, our results should contribute towards a better understanding of the factors involved in the response to EPO therapy. Elucidating these factors not only has an intrinsic relevance per se (as a means of better correcting the anaemic state), but may also be useful in helping to identify patients at high risk of morbidity and mortality.