Particularities of nutritional status in patients with diabetes mellitus on maintenance hemodialysis

Background: unfavorable changes in nutrition and body composition is highly prevalent in patients with chronic kidney disease (CKD) on hemodialysis. Diabetes mellites type 2 (DM2) coupled with CKD should be considered as an additional factor for nutrition abnormalities in dialysis patients due to more a prominent inflammatory status and insulin resistance. Only limited number of investigations addressed the nutritional status of patients with combined CKD and DM2 pathology, in spite of increasing number of patients with diabetes in the dialysis population. Objectives: the aims of our study were to compare the nutritional status in hemodialysis patients with and without DM2 and to evaluate relationship between nutritional status parameters and inflammatory markers. Methods: 79 dialysis patients (50 to 70 years) were divided in two groups: 40 with DM2 and 39 without it. In the DM2 group. None of the patients hade heavy diabetes complications or decompensation. The examination included anthropometry, measurement of body composition by bioimpedance analysis, biochemical assays (including the main parameters of nutritional status and inflammation). All patients kept a 3-days food diary for assessment of nutrient and energy intake. Results: the groups did not differ by age, gender, comorbidity, dialysis duration and adequacy. BMI and degree of abdominal obesity were significantly higher in the DM2 group, but lean mass (LM), handgrip strength and gait velocity were significantly less. The transthyretin level, a more accurate characterizes of protein-energy waste than albumin was significantly decreased in the DM2 group. The levels of AGE and CRP did not differ between the groups, although were twice higher than normal values. Other inflammatory markers (IL1, IL6) were significantly higher in the DM2 group. Protein and energy intake were under dietary recommendations for patients in the DM2 group. A positive correlation between protein intake and levels of albumin and transthyretin and negative association with IL1, IL6 and AGE in patients with DM2 was identified. A negative correlation between LM and CRP was found in patients without DM2. Conclusion: persistent inflammation and sarcopenia were more prominent in hemodialysis patients with DM2. An absence of appetite due to inflammation is a probable cause of low protein and energy intake in those patients.

белково-энергетическая недостаточность, нутриционный статус, программный гемодиализ, сахарный диабет II типа, protein-energy wasting, nutritional status, maintenance hemodialysis, diabetes mellitus type 2

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