Protein Energy Wasting in a Cohort of Maintenance Hemodialysis Patients in Dhaka, Bangladesh

Malnutrition is associated with high rates of mortality among patients with end stage kidney disease (ESKD). There is a paucity of data from Bangladesh, where around 35,000-40,000 people reach ESKD annually. We assessed protein-energy wasting (PEW) amongst 133 patients at a single hemodialysis setting in Dhaka. Patients were 49% male, age 50 +/- 13 years, 62% were on twice-weekly hemodialysis. Anthropometric, biochemical, and laboratory evaluations revealed: BMI 24.1 +/- 5.2 kg/m(2), mid-arm muscle circumference (MAMC) 21.6 +/- 3.6 cm, and serum albumin 3.7 +/- 0.6 g/dL. Based on published criteria, 18% patients had PEW and for these patients, BMI (19.8 +/- 2.4 vs. 25.2 +/- 5.2 kg/m(2)), MAMC (19.4 +/- 2.4 vs. 22.2 +/- 3.8 cm), serum albumin (3.5 +/- 0.7 vs. 3.8 +/- 0.5 g/dL), and total cholesterol (135 +/- 34 vs. 159 +/- 40 mg/dL), were significantly lower as compared to non-PEW patients, while hand grip strength was similar (19.5 +/- 7.6 vs. 19.7 +/- 7.3 kg). Inflammatory C-reactive protein levels tended to be higher in the PEW group (20.0 +/- 34.8 vs. 10.0 +/- 13.9 p = 0.065). Lipoprotein analyses revealed PEW patients had significantly lower low density lipoprotein cholesterol (71 +/- 29 vs. 88 +/- 31 mg/dL, p < 0.05) and plasma triglyceride (132 +/- 51 vs. 189 +/- 103 mg/dL, p < 0.05), while high density lipoprotein cholesterol was similar. Nutritional assessments using a single 24 h recall were possible from 115 of the patients, but only 66 of these were acceptable reporters. Amongst these, while no major differences were noted between PEW and non-PEW patients, the majority of patients did not meet dietary recommendations for energy, protein, fiber, and several micronutrients (in some cases intakes were 60-90% below recommendations). Malnutrition Inflammation Scores were significantly higher in PEW patients (7.6 +/- 3.1 vs. 5.3 +/- 2.7 p < 0.004). No discernible differences were apparent in measured parameters between patients on twice- vs. thrice-weekly dialysis. Data from a larger cohort are needed prior to establishing patient-management guidelines for PEW in this population.