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BACKGROUND: Malnutrition and high serum phosphate is highly prevalent among haemodialysis patients in Malaysia. Hyperphosphatemia is a predisposing factor of cardiovascular death among haemodialysis patients. Both malnutrition and hyperphosphatemia are well established predictors of increased morbidity and mortality of haemodialysis patients.
OBJECTIVES: The aim of this study is to determine the association between protein energy malnutrition and hyperphosphatemia among haemodialysis patients.
METHODS: A cross-sectional study was carried put among 100 haemodialysis patients in dialysis centres around Klang Valley. Patients were verbally interviewed to obtain demographic data, medical history and diet history. Serum phosphate and albumin were recorded from medical records. Malnutrition was classified using the Dialysis Malnutrition Score (DMS).
RESULTS: A total of 70% of the patients were well-nourished while 30% were malnourished according to DMS scores classification. 53% of the patients had hyperphosphatemia (i.e. serum phosphate > 1.78 mmol/l). The well-nourished patients had significantly higher serum phospate compared to malnourished patients (i.e 1.88 ± 0.48 mmol/L vs 1.65 ± 0.39 mmol/L; p = 0.02) and serum albumin levels were also significantly higher among well-nourished patients. (i.e 40 ± 3 g/L vs 39 ± 3 g/L; p = 0.01). This was supported by finding that DMS score was negatively correlated with serum phosphate level (r = -0.219, p = 0.029). Serum phosphate also had significant positive association with dietary protein intake (r = 0.229, p = 0.022) and serum albumin (r = 0.212, p = 0.03).
CONCLUSION: Well-nourished patients are prone to hyperphosphatemia possibly contributed by higher protein intake which is a major source of phosphate. There is a need to determine the adequate level of dietary protein intake which will not compromise on malnutrition status.
Keywords - Haemodialysis, Malnutrition, Hyperphosphatemia, Dialysis Malnutrition Score
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