Clinical Significance of Nutritional Status, Inflammation, and Body Composition in Elderly Hemodialysis Patients-A Case-Control Study

Abstract

Nutritional and inflammatory disorders are factors that increase the risk of adverse clinical outcomes and mortality in elderly hemodialysis (HD) patients. This study aimed to examine nutritional and inflammation status as well as body composition in older adults on HD compared to matched controls. A case-control study was conducted on 168 older participants (84 HD patients (cases) and 84 controls) age- and sex-matched. Demographic, clinical, anthropometric, and laboratory parameters were collected from medical records. The primary outcome was nutritional status assessment using a combination of nutritional and inflammatory markers along with the geriatric nutritional risk index (GNRI). Sarcopenic obesity (SO) was studied by the combined application of anthropometric measures. Body composition and hydration status were assessed by bioelectrical impedance analysis (BIA). Univariate and multivariate regression analyses were performed to identify nutritional and inflammatory independent risk indicators in elderly HD patients and controls. A significantly high prevalence of nutritional risk measured by the GNRI was found in HD patients (32.1%) compared to controls (6.0%) (p < 0.001). Elderly HD patients were overweight and had lower percent arm muscle circumference, phase angle (PA), serum albumin (s-albumin), as well as higher percent extracellular body water (ECW%) and serum C-reactive protein (s-CRP) than controls (all at least, p < 0.01). SO was higher in HD patients (15.50%) than in controls (14.30%). By multi-regression analyses, age < 75 years (OR: 0.119; 95%CI: 0.036 to 0.388), ECW% (OR: 1.162; 95%CI: 1.061 to 1.273), PA (OR: 0.099; 95%CI: 0.036 to 0.271), as well as BMI, s-albumin ≥ 3.8 g/dL, and lower s-CRP were independently related between cases and controls (all at least, p < 0.05). Elderly HD patients had increased nutritional risk, SO, inflammation, overhydration, and metabolic derangements compared to controls. This study highlights the importance of identifying nutritional risk along with inflammation profile and associated body composition disorders in the nutritional care of elderly HD patients. Further studies are needed to prevent nutritional disorders in elderly HD patients.

Keywords: aging; bioimpedance analysis; body composition; case–control study; elderly; geriatric nutritional risk; hemodialysis; inflammation; obesity; older adults; phase angle; s-albumin; sarcopenic obesity.

Figure 1

Flowchart of the recruitment and selection of cases and controls in the study. HD, hemodialysis.

Figure 2

Body composition parameters in hemodialysis patients and controls. Values are expressed in percentages (%). * p < 0.001.

Figure 3

Distribution of hydration status and body cell mass in hemodialysis patients (cases) and controls. BCM%, percentage of body cell mass; ECW%, percentage of extracellular water; ICW%, percentage of intracellular water; TBW%, percentage of total body water. * p = 0.006; ** p < 0.001.

Figure 4

Heatmap correlation matrix of the geriatric nutritional risk index with various anthropometric, body composition, and laboratory parameters in (a) cases and (b) controls. Correlation is defined by the correlation coefficient (r). The degree of correlation was classified based on the r coefficient as very weak (r: 0.20–0.39), weak (r: 0.40–0.59), moderate (r: 0.60–0.79), and strong (r: 0.80–1.00) [47]. BCM (kg), body cell mass; s-CRP, serum C-reactive protein; ECW%, percentage of extracellular water; FM%, percentage of fat mass; GNRI, geriatric nutritional risk index; MAMC%, percentage of mid-arm-muscle circumference; Na/K, exchangeable Na/K; PA, phase angle; s-Prealbumin, serum prealbumin; SKF%, percentage of triceps skinfold thickness.

Figure 5

Prevalence of nutritional disorders in older hemodialysis patients and controls based on nutritional marker thresholds proposed for diagnosing and evaluating nutritional status. Values are expressed in percentages (%).