Body water distribution and nutrition status of end stage renal disease patients undergoing hemodialysis at Moi Teaching and Referral Hospital (MTRH)

Abstract

Background: Fluid balance management among hemodialysis patients is necessary in preventing both under and over hydration. Fluid imbalance has been associated with the development of both cardiovascular complications and Intradialytic morbidity. Currently, dry weight assessment is clinical and has been found to be inaccurate. Recent studies have shown that the use of bioimpedance analysis (BIA) is a more objective way of assessing body water distribution and can accurately determine dry weight and nutritional status. The ability to accurately assess dry weight is necessary in managing fluid balance, reducing cardiovascular complications and improving a patient’s quality of life. Objective: To determine the body water distribution among patients on hemodialysis at Moi Teaching and Referral Hospital. Methodology: This was a descriptive cross sectional study conducted at the Moi Teaching and Referral Hospital in Eldoret Kenya, among 51 end-stage renal disease patients on hemodialysis. The inclusion criteria were: adult over the age of 18, who were on regular maintenance hemodialysis for more than 3 months and had achieved their dry weight regarded as adequate according to the patients’ responsible doctor or nurse. The exclusion criteria included patients who had heart failure, those who had neoplastic conditions, those who were on regular steroids, patients with limb amputation and patients with metallic devices, like pacemakers and artificial joints. Following hemodialysis, each patient was weighed using a calibrated weighing scale to assess the clinical dry weight. The height of each patient was taken before conducting BIA procedure using Body Composition machine where reactance and resistance values were obtained. All the results were entered into the Cyprus 2.7, a Body Composition Analysis software, to determine the body composition. Data was analyzed using STATA statistical software version 12 where the descriptive statistics were presented in terms of mean, median and inter-quartile range. The test of difference was determined using one sample t-test. Results: The 51 participants had a mean age of 47 years; 32 (63%) were males. 28 (55%) were attending 2 dialysis sessions a week while the rest had a single session. The average excess extracellular fluid (ECF) among all the participants was 1.5 litres(std:3.0), p-value <0.005; however, only 35 (69%) had excess ECF after clinical assessment with a mean of 3.0 liters(std:2.03).p-value<0.001. 42(82%) participants were malnourished(Body Mass Index<22kg/m2 and phase angle<5). There was no statistically significant differences in Extracellular Fluid, Total Body Water, Body Mass Index, Body Cellular Mass, Free Fat Mass and phase angle between participants who had one dialysis session and those who had two. Conclusion and Recommendation: The clinical method underestimated the excess ECF and this could predispose dialysis patients to complications associated with fluid imbalance. Most of the patients were also found to be malnourished. This study recommends the incorporation of BIA in the assessment of dry weight and nutritional status among hemodialysis patients in the clinical set-up.