Malnutrition in Haemodialysis Patients

Introduction
Malnutrition is common in haemodialysis patients due to specific characteristics of chronic renal insufficiency such as insufficient filtration ability and accelerated protein degradation. A deteriorated nutritional condition threats chronic dialysis patients lowered mobility and poor outcome include increased mortality (Carrero et al., 2013; Locatelli et al., 2002; Vannini, Antunes, Caramori, Martin, & Barretti, 2009). Thus there are several malnutrition indicators of haemodialysis patients were proposed such as SGA, GNRI and albumin level. Nevertheless, detection rate of each indicators seems to differ to each other (Pifer et al., 2002) and consideration of particular characteristics of haemodialysis patients is required for the practical apply. Hence, use of sensitive identifying assessment method and early intervention on malnourished patients are quite meaningful.

Malnutrition and mortality in haemodialysis patients
Characteristics of haemodialysis patients are described as they have greater survive when they had a higher serum creatinine concentration or higher BMI which stand for larger body size or greater muscle mass. An increase of dry weight with muscle mass gaining correlates to the greatest survival. On the other hand, weight loss with loss of muscle mass results the worst mortality. Additionally, gain in muscle mass with weight loss was advantaged on higher survival in comparison with loss of muscle mass with weight gain (Kalantar-Zadeh et al., 2010). Mortality risk is strongly associates to a low BMI in maintenance haemodialysis patients (Kovesdy & Kalantar-Zadeh, 2009).

Mortality risk is analysed using mSGA (modified subjective global assessment) score which contains recent weight loss, visual soma...

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...ce are the main components of the impedance of a biological tissue. BIA measures the impedance or resistance using a faint electric current through the body. Body composition is estimated using the difference in the conductivity of the electric current between extracellular fluid and body tissues since impedance is higher in fat tissue, which contains lesser fluid in the tissue than lean body mass. The reliability and validity of BIA testing to estimate lean body mass and total body fat among haemodialysis patients are proved by several studies (Chertow et al., 1995, Frstenberg & Davenport, 2011). However, this method is not available for people who had a medical device implantation such as a pacemaker or an impedance cardioverter defibrillator since these medical equipments may have interfered by BIA testing due to the use of an electric current through the body.