Malnutrition Inflammation Complex Syndrome Among Ambulant End Stage Renal Disease Patients On Maintenance Haemodialysis At Kenyatta National Hospital

Abstract

Background: Malnutrition and inflammation are highly prevalent conditions among maintenance haemodialysis (MHD) patients and are often co-existent, consequently being referred to as Malnutrition Inflammation Complex Syndrome (MICS). MICS, or its individual components, negatively impact morbidity and mortality outcomes in MHD patients. There is a knowledge gap on the burden of MICS and its determinants among MHD patients at Kenyatta National Hospital (KNH) and this study sought to fill part of the gap. Objectives: The objective of this study was to determine the burden and correlates of malnutrition and inflammation among ambulant haemodialysis patients at KNH. Design: This was a cross-sectional descriptive study. Setting and Population: The study was done at the KNH renal unit among one hundred and thirty four patients on MHD. Methods: Relevant clinical, socio-demographic and nutritional history were obtained from the patient and file. A general and focused physical examination was done to get information on height, weight, sub cutaneous fat and muscle loss and these were entered into the Malnutrition Inflammation Score sheet and patient proforma. Blood samples were taken for C-Reactive protein (CRP), Albumin and Total Iron Binding Capacity (TIBC). The prevalence and severity of MICS was determined using the Malnutrition Inflammation Score (MIS) at a score of 6 and above. Data analysis was done using the statistical package for social sciences (SPSS) version 21.0. Results: A total of 134 patients were recruited into the study between December 2015 and January 2016. The mean (SD) age was 44.2 (15.8) years. Male to female ratio was 1.6:1. The commonest aetiology of ESRD was hypertension at 45.5%. The prevalence of MICS was 61.2% with 100% of the study patients having above normal CRP levels (5mg/ml). Of the 82 patients with MICS, 22% had moderate to severe MICS. MICS was only found to be significantly associated with female gender (p=0.013). The correlation between MICS and CRP was insignificant with a pearson’s correlation co-efficient, r, of 0.015 (p = 0.865). Conclusion: This study demonstrated a high prevalence of MICS at the KNH renal unit with a significant number of patients having moderate to severe MICS.