Critical review of the article on ‘Study of the nutritional status of end-stage renal disease patients on maintenance hemodialysis in Hawary Kidney center and nephrology unit at Benghazi Medical Center’

Citation: Elramli, S. S. (2022). Study of the nutritional status of end-stage renal disease patients on maintenance hemodialysis in Benghazi. Clinical Medicine Insights, 3(1), 268-277

The aim of this cross-sectional study was to determine the prevalence of nutritional deficiencies, assess the association between nutritional status and hemodialysis, and identify the effects of patient factors on nutrition among 155 Libyan dialysis patients. Nutritional status was evaluated using Subjective Global Assessment (SGA) scores, BMI, serum albumin, and dietary intake analysis. The key findings were a high prevalence of malnutrition (39%), significant positive correlation of SGA scores with BMI and albumin indicating their utility in nutritional screening, and no association between nutritional status and dialysis frequency/duration. The study concludes that routine nutritional monitoring is essential to enable early detection of malnutrition in dialysis patients along with timely interventions involving dietary counselling and management of comorbidities. Further studies must compare nourished and malnourished patients to explain the differentiating characteristics and guide targeted interventions to improve nutritional status among haemodialysis patients.

The importance of this study lies in addressing the high malnutrition prevalence and associated adverse outcomes seen in dialysis patients. Despite the survival benefits of renal replacement therapy (Such as, haemodialysis, continuous ambulatory peritoneal dialysis), protein-energy wasting and nutritional deficiencies precipitate morbidity and mortality in this population. Assessing nutritional status by comprehensive means including the Subjective Global Assessment allows early detection of nutritional decline so that prompt interventions can ensue to improve prognosis.
The sample size of 155 patients is adequate for the study objectives and statistical power. However, consecutive sampling and inclusion of patients from only two facilities limits generalization of the prevalence data. Multi-centre studies with probability sampling would be ideal. The inclusion and exclusion criteria are well-defined.

The nutritional assessment adopted a multidimensional approach using subjective scoring, body composition and biochemical parameters allowing comprehensive evaluation. The adequate sample size ensures generalizability of the prevalence data. However, certain aspects could have augmented the reliability of results. Details on dialysis adequacy were lacking although treatment adequacy impacts nutritional status. Dietary surveys were based solely on one-day recall rather than three-day records thereby compromising accuracy of nutrition intake data.
Analysis of socioeconomic factors influencing dietary compliance was also missing. Additionally, comparative analysis between well-nourished and malnourished subjects was warranted to identify differentiating attributes and predictors of malnutrition through advanced statistics. Nevertheless, the significant positive correlation between nutrition scores and albumin levels is an important finding.
Basic descriptive analysis for study variables was done. Correlation of SGA with BMI and select blood parameters gave useful insights into their utility for nutritional screening. However, multivariate regression analysis could have delineated independent predictors of malnutrition like comorbidities, dialysis vintage etc. Comparing results to related literature would aid in contextual interpretation and validation of this relationship.

The study provides valuable data on high prevalence of malnutrition among Libyan dialysis patients. Low BMI and albumin levels correlated strongly with malnutrition by SGA criteria. Further studies must investigate underlying mechanisms, socioeconomic factors, and compare dietary intake and dialysis adequacy between nourished and malnourished patients. This can aid tailored interventions to improve nutritional status and patient outcomes. Implementation of routine nutritional status screening is also warranted. And, the study findings are compared well with some past literature. Independent conclusions are drawn regarding high malnutrition prevalence. Addressing a few methodological limitations and extending the analyses would enrich the findings and policy implications.


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