Can Overnutrition Lead to Wasting?-The Paradox of Diabetes Mellitus in End-Stage Renal Disease Treated with Maintenance Hemodialysis

Nutrients. 2022 Jan 7;14(2):247. doi: 10.3390/nu14020247.

Abstract

Background: The population of end-stage renal disease (ESRD) patients with diabetes mellitus (DM) may be at increased risk of protein energy wasting (PEW). The aim of the study was to investigate the impact of DM on selected indicators of PEW in the ESRD population that was undergoing maintenance hemodialysis (MHD).

Methods: A total of 515 MHD patients were divided into two subgroups with and without DM. The evaluation of diet composition, Charlson Comorbidity Index (CCI), SGA, and laboratory and BIS analyses were performed. All-cause and cardiovascular mortality was recorded.

Results: DM patients had lower albumin (3.93 (3.61-4.20) vs. 4.10 (3.80-4.30) g/dL, p < 0.01), total cholesterol (158 (133-196) vs. 180 (148-206) mg/dL, p < 0.01), and creatinine (6.34 (5.08-7.33) vs. 7.12 (5.70-8.51) mg/dL, p < 0.05). SGA score (12.0 (10.0-15.0) vs. 11.0 (9.0-13.0) points, p < 0.001), BMI (27.9 (24.4-31.8) vs. 25.6 (22.9-28.8) kg/m2, p < 0.001), fat tissue index (15.0 (11.4-19.6) vs. 12.8 (9.6-16.0) %, p < 0.001), and overhydration (2.1 (1.2-4.1) vs. 1.8 (0.7, 2.7) L, p < 0.001) were higher in the DM group. Increased morbidity, reflected in the CCI and mortality-both all-cause and cardiovascular-were observed in DM patients.

Conclusions: Hemodialysis recipients with DM experience overnutrition with a paradoxically higher predisposition to PEW, expressed by a higher SGA score and lower serum markers of nutrition. This population is also more comorbid and is at higher risk of death, including from cardiovascular causes.

Keywords: Subjective Global Assessment (SGA); bioelectrical impedance spectroscopy (BIS); body composition; diabetes mellitus (DM); dietary intake; end-stage renal disease (ESRD); hemodialysis (HD); mortality; obese sarcopenia; protein energy wasting (PEW).

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adipose Tissue
  • Aged
  • Biomarkers / blood
  • Body Composition
  • Body Mass Index
  • Cardiovascular Diseases / mortality
  • Cause of Death
  • Cholesterol / blood
  • Comorbidity
  • Creatinine / blood
  • Diabetes Complications / blood
  • Diabetes Complications / complications*
  • Diabetes Complications / mortality
  • Diabetes Mellitus* / blood
  • Diagnostic Self Evaluation
  • Diet
  • Electric Impedance
  • Female
  • Humans
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Overnutrition / complications*
  • Prospective Studies
  • Protein-Energy Malnutrition / etiology*
  • Renal Dialysis*
  • Serum Albumin / analysis

Substances

  • Biomarkers
  • Serum Albumin
  • Cholesterol
  • Creatinine