The deetermination of nutrition related cardiovascular risk factors inhemodialysis patients with end-stage chronic renal failure

This study was conducted to determine the nutrition related cardiovascular riskfactors in end-stage renal disease (ESRD) patients. The study was planned on93 chronic renal failure patients (50 male, 43 female) ages between 18-65 yearsold at Baskent University Ankara Hospital Hemodialysis Unit betweenDecember 2006 and August 2007. A questionaire was applied to patientsincluding demografic and disease information. The nutritional status of thepatients was determined by food-frequency questionaire, a three-d 24-h dietaryrecord and Subjective Global Assessment (SGA). The quality of the patientswas assessed by SF-36 questionaire. Some biochemical parameters,anthropometric measurements and physical activity levels of the patients werealso determined. The mean age of the patients was 45.1±12.50 years andmean duration of undergoing in hemodialysis was 10.0±4.67 years. Accordingto SGA results, the percentage of well-nourished patients was 52.7%,moderately-malnourished patients was 36.6% and severely-malnourishedpatients was 10.8%. The evaluation of nutritional status of the patients both inhemodialysis and non-hemodialysis days the 69.9% of the patients? dietaryenergy and protein intakes were in sufficient. The life quality of the patientswere low and the women?s scores were lower than men?s (p<0.05). When thetraditional, kidney depending and nutritional cardiovascular risk factors wereassessed, the 69.9% of the patients had anemia. The percentages of thepatients? serum total cholesterol, LDL-cholesterol, triglycerid and totalcholesterol/ LDL cholesterol levels which were higher than NKF and ATPIIIcriteria were 7.5%, 4.3%, 43%, 10.8% respectively; the percentage of thepatients? serum HDL-cholesterol level which were lower than NKF and ATPIIIcriteria was 41.9%. There were significant correlations between serum totalcholesterol and MAMC, dietary MUFA, PUFA, fiber and daily egg consumptions(p<0.05). In this study the 93.5% of the patients had hyperhomocysteinemiaand 51.6% had high serum CRP levels. There were significant correlationsbetween serum homocysteine and serum folic acid and serum vitamin B12 levelsin patients. Acoording to serum albumin levels 44.1% of the patients were inmalnutrition. There were significant correlations between serum albumin levelsand serum creatinine, CRP and quality of life measures (p<0.0.5). The 98.9% ofthe patients? dietary total fat intakes were higher than NKF and ATPIII criteriaand all patients dietary saturated fat intake were above than recommendations.The 87.1% of the patients? dietary. PUFA/SFA ratio was <1. Also according toNKF recommendations the percentages of the patients who had insufficientdietary folat and vitamin B12 intake were 100% and 61.3% respectively. Therewere positive correlations between serum vitamin B12 levels and dietary vitaminBB12 intakes (p<0.05). As a conclusion, the hemodialysis patients should beconsidered to be at high risk for developing cardiovascular disease. İt is for thisreason, while planning the ESRD patients? diet it should be so important toconsider nutrition related cardiovasular disease risk factors for life quality andfor survival.Key words: Hemodialysis, cardiovascular risk factors, homocysteine, quality oflife, nutritional status