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Title:	Studies on protein energy wasting in Malaysian haemodialysis patients
Supervisor:	Abdul Halim Abdul Gafor, Prof. Dr.
Keywords:	Renal Dialysis Universiti Kebangsaan Malaysia -- Dissertations Dissertations, Academic -- Malaysia
Issue Date:	22-Sep-2020
Description:	Protein energy wasting (PEW) is a severe form of malnutrition commonly occurring in Stage 5 chronic kidney disease patients. PEW is a known predictor of mortality and poor prognosis in haemodialysis (HD) patients. Three studies were planned to explore PEW in Malaysian HD patients namely (i) Study I: a cross-sectional study to determine the prevalence of PEW (ii) Study II: examining the applicability of ultrasound imaging (UI) method to identify PEW risk, and (iii) Study III: a multicentred randomized, open label controlled trial to evaluate the effects of oral nutritional supplementation (ONS) and standard nutrition counseling (NC) in improving the nutritional status of HD patients with PEW. Study I recruited a total of 427 HD patients and PEW was determined using the International Society of Renal Nutrition and Metabolism (ISRNM) criteria. Prevalence of PEW was 20.4% (n=87) with 65.5% (n=57) patients meeting the ISRNM criteria of BMI<23 kg/m2, mid-arm muscle circumference>10% of reduction compared to standard reference, and poor dietary intake (DEI<25 kcal/kg IBW). In Study II, 351 patients recruited from Study I undergone UI scanning of the quadriceps muscle of both legs during their HD session. The muscle thickness of the rectus femoris (RF) and vastus intermedius (VI) muscle, as well as the cross-sectional area of RF muscle (RFCSA) were measured. Mann- Whitney U tested differences in UI measures between PEW and non-PEW patients, revealing significantly lower muscle thickness and RFCSA in PEW patients, irrespective of gender (all p<0.001). By receiving operating characteristic analysis, RFCSA elicited the greatest area under the curve in identifying patients at risk of PEW compared for other UI sites (men= 0.74, 95% CI: 0.66-0.82, p<0.001; women= 0.80, 95% CI: 0.70-0.90, p<0.001). In Study III, consenting PEW patients from Study I were randomized to intervention group (ONS+NC, n=29) and control group (NC, n=27). ONS+NC group received commercial renal-specific ONS liquid formula providing 475 kcal and 21.7 g of protein daily for a period of six months. Both groups also received standard NC during the study period. Nutritional parameters were analyzed for between and within group differences using general linear model test. ONS+NC group had a significant increase in dry weight (+1.58 ± 2.46 kg vs +0.13 ± 1.96 kg, p=0.007, d=0.89) and BMI (+0.44 ± 0.87 kg/m2 vs +0.19 ± 0.75 kg/m2, p=0.045, d=0.42) compared to NC group. ONS+NC group also had increasing trend for serum albumin (+0.31 ± 3.59 g/L, p=0.490, d=0.09) with significant increase in serum prealbumin (+0.03 ± 0.06 g/L, p=0.013, d=0.60) and nPCR (+0.16 ± 0.29g/kg/day, p=0.015, d=0.50). Severity of malnutrition as per MIS score significantly decreased within ONS+NC group (-1.59 ± 2.64, p=0.012, d=0.58) and between group (p=0.002, d=1.96). There were no changes in muscle and fat mass, UI parameters and quality of life within or between group (all p>0.05). ONS+NC group achieved dietary adequacy compared to NC group for both energy (32.25 ± 6.86 kcal/kg IBW vs 24.68 ± 6.99 kcal/kg IBW, p=0.001, d=2.35) and protein intakes (1.32 ± 0.33g/ kg IBW vs 1.00 ± 0.45 g/kg IBW, p=0.009, d=0.85). In conclusion, PEW was prevalent in the Malaysian HD population, the RFCSA parameter measured by UI method was able to identify PEW risk in patients and provision of ONS was shown to improve PEW status.,Doktor Falsafah
Pages:	128
Call Number:	9 Tesis WJ378.S531s 2020
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Health Sciences / Fakulti Sains Kesihatan

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