Predictors of malnutrition in Australian haemodialysis patients and comparison of dietary protein intakes to national guidelines

Background: Malnutrition is an important concern for patients undergoing dialysis therapy. We aimed to investigate predictors of nutritional status in a population of in-centre Western Australian haemodialysis (HD) patients and compare dietary protein intakes to national guidelines of 1.2-1.4 g/kg body weight/day. Method: Dietary intakes were assessed by diet history interview for 35 in-centre patients receiving HD (mean age 65.2 ± 13.1 years; median dialysis vintage 3 [IQR 22] months). Patient Generated Subjective Global Assessment was used to classify patients as well-nourished or malnourished. Patient characteristics, co-morbidities and dialysis vintage were investigated along with biochemical data. Logistic regression was used to determine which factors were independent predictors of malnutrition. Results: Out of the 35 patients, 54% (n=19) were classified as well-nourished with 46% (n=16) malnourished. Increased body mass index, protein intake and albumin were independently associated with lower odds of malnutrition. A mean protein intake of 1.05 ± 0.33 g/kg/d was observed in the well-nourished group compared with 0.86 ± 0.28 g/kg/d for the malnourished group. Only one patient in each group (malnourished and well-nourished) was within the recommended protein intake guidelines (1.2-1.4 g/kg/d). Conclusion: Malnutrition remains a problem for HD patients, and dietary protein intake is an important predictor. However, our findings suggest that patients may be well-nourished at protein intakes lower than the current Australian guidelines. Further research investigating the application of the international protein intake guidelines of 1.1-1.2 g/kg/d for maintenance of nutritional status in clinically stable dialysis patients in Australia may be useful.