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British Journal of Healthcare and Medical Research - Vol. 10, No. 1
Publication Date: February 25, 2023
DOI:10.14738/jbemi.101.13245.
Sulaiman, Y. Y., Dunga, J. A., Musa, J. J. Adamu, Y. M., Abubakar, A. M., Liman, H. U., Vakkai, I., Sahabi, M. A., Zawaya, K. P., Vandi,
Z. G., Jauro, P., Adamu, B. G., & Agaba, E. I. (2023). Markers of Malnutrition among Dialysis Naïve CKD Patients in North Central
Nigeria. British Journal of Healthcare and Medical Research, Vol - 10(1). 364-381.
Services for Science and Education – United Kingdom
Markers of Malnutrition among Dialysis Naïve CKD Patients in
North Central Nigeria
Yarima Y Sulaiman
Modibbo Adama University Teaching Hospital Yola, Nigeria
Jacob A Dunga
Dept. of Internal medicine,
Abubakar Tafawa Balewa University Teaching Hospital Bauchi state, Nigeria
Jafiada J Musa
Dept. of Internal medicine,
Abubakar Tafawa Balewa University Teaching Hospital Bauchi state, Nigeria
Yakubu M Adamu
US Dept. of Defense, Walter Reed Program, Abuja, Nigeria.
Auwal M Abubakar
Modibbo Adama University Teaching Hospital Yola, Nigeria
Haruna Usman Liman
Dept. of Internal medicine,
Abubakar Tafawa Balewa University Teaching Hospital Bauchi state, Nigeria
Innocent Vakkai
Taraba state ministry of health, Nigeria
Muhammad A Sahabi
Modibbo Adama University Teaching Hospital Yola, Nigeria
Kefas P Zawaya
Dept. of Medicine Federal Medical Center Gombe state, Nigeria.
Zira G Vandi
Modibbo Adama University Teaching Hospital Yola, Nigeria
Pobe Jauro
Dept. of Medicine Federal Medical Center Gombe state, Nigeria.
Adamu Bakari G
Modibbo Adama University Teaching Hospital Yola, Nigeria
Agaba, E. I.
Dept. of Internal medicine, Jos University Teaching Hospital, plateau state, Nigeria
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British Journal of Healthcare and Medical Research (BJHMR) Vol 10, Issue 1, February - 2023
Services for Science and Education – United Kingdom
Abnormal metabolism of albumin has also been reported in these patients including
redistribution of albumin into the interstitium, decrease synthesis and external loss of albumin
[11]. Protein catabolism is further increased in patients undergoing hemodialysis with
incompatible membranes. Spontaneous dietary intake of protein and energy tends to decline
with renal insufficiency. The calorie intake was significantly higher among patients with
fractional Urea clearance (Kt/v) of at least 1.7 and glomerular filtration rate (GFR)
>0.5mls/min/1.73m2 compared to patients with same Kt/v but with GFR
<0.5mls/min/1.73m2.[12] suggesting a clear risk of malnutrition among CKD patients.
Malnutrition has been shown to be a risk factor for cardiovascular mortality. In a study done
with the aim of assessing the relationship between nutritional indices and cardiovascular
mortality among patients with ESRD, it was shown that the risk for cardiovascular death was
39% greater for each 1g/sdl(10g/l) decrement in serum albumin levels. A care provider’s
assessment of malnutrition was associated with a 27% greater risk for cardiovascular mortality.
For one-unit decrement in body mass index (BMI), the risk for cardiovascular disease (CVD)
was 6% greater [13].
Patients with CKD are at risk for malnutrition because uremic symptoms (anorexia, nausea,
vomiting and altered taste) are superimposed on the restricted diet, malabsorption, and urinary
protein losses. This often results in hypoalbuminemia, abnormal profiles of blood amino acid
levels, decreased protein and fat stores, and deranged white blood cell function. The institution
of appropriate diet or initiation of dialysis therapy may not, however, correct these deficits. It is
frequently necessary to enlist the aid of a clinical nutritionist to assist in an aggressive program
of enteral or parental nutrition. This includes the careful monitoring of nutritional parameters,
such as serum pre-albumin, albumin, and anthropometric measurements of fat and muscle bulk,
triceps skinfold thickness and mid-arm muscle circumference). Performance of the subjective
global assessment has also become an important tool used to quantify and periodically monitor
the nutritional status of CKD patients [14]. This tool has been modified for use in renal failure
and is still undergoing revisions and validation in subsets of patients. Currently, brief training is
reconsidered for rating the four items (weight change over preceding 6 months, dietary intake
and gastrointestinal symptoms, visual assessment of subcutaneous tissue for fat and muscle
wasting, and muscle mass) on a seven-point scale.
Clinical and biochemical indices, such as body mass index (BMI), skin fold thickness, serum pre- albumin and albumin, serum cholesterol, total lymphocyte count, and C-reactive protein [15-
23] have been used as markers of malnutrition in CKD. However, none of these methods is
sufficient on their own in the assessment of malnutrition, hence a combination of methods is
used. This study is however intended to correlate biochemical parameters with subjective
global assessment (SGA) in the assessment of malnutrition in pre-dialysis CKD patients in north
central Nigeria. SGA focuses on gastrointestinal symptoms (anorexia, nausea, vomiting,
diarrhea), weight loss in the preceding six months in the absence of other causes and visual
assessment of subcutaneous tissue and muscle mass [24]. SGA is rated using the SGA rating
form. The overall score classification is not simply numerical score. It does strongly depend on
the clinical judgment of the examiner. He/ She has to consider whether the patient’s status is
improving or deteriorating. This information may lead to different “scores” given in each
section. The scores are subjectively rated on a four point or seven-point scale [25]. The use of
seven-point scale is recommended because of its greater sensitivity and its use in large scale
epidemiologic studies such as Canadian United State of America (CANUSA) study [26]. In