Relationship between the malnutrition and ambulatory blood pressure parameters in hemodialysis patients

Background: The aim of this study is to investigate the relationship between the degree of malnutrition and inadequate volume control evidenced by ambulatory blood pressure (ABP) patterns.Methods: In this study 148 chronic hemodialysis patients were investigated in a cross-sectional manner. Malnutrition score was calculated using Subjective Global Assessment. Each case was evaluated in terms of the weight change, dietary intake, gastrointestinal symptoms, the presence and severity of comorbidities, functional capacity, signs of muscle wasting, decreased fat stores or loss of subcutaneous fat. Scores of 1 to 5 was given to each category according to the severity of the symptoms and physical examination findings. ABP monitorization was performed in all patients.Results: The mean age of the patients was 58 ± 15 years, their mean dialysis duration 31 ± 16 months. The mean malnutrition score was 19 ± 6 points. The highest malnutrition score and lowes albumine levels were observed to be present in reverse-dipper pattern. A positive correlation between malnutrition index and mean night sistolic blood pressure, mean night arterial blood pressure, mean 24 hours arterial blood pressure, night sistolic blood pressure variability has been found in the bivariete and multivariete analysis. On the other hand a negative correlation between malnutrition index and triceps skin-fold, mid-arm muscle circumference, albumine levels has been found.Conclusion: Although it is a well-known fact that malnutrition is a strong risk factor for increased cardiovascular mortality and morbidity in hemodialysis patients, again there is not any study in the literature elucidating the possible relation between malnutrition and ABP parameters. The results of our study show that the progressive worsening in the nutritional status follows a parallel course along with the deterioriation in ABP parameters concerning hypervolemia. This in turn suggests that increasing degrees of malnutrition are associated with more profound derangements in the volume status. In conclusion, further prospective studies with larger sample size, more sophisticated biochemical parameters, incorporating the effects of the renin-angiotensin-aldosteron system and sympathetic overactivity on the ABP parameters are urgently needed.