Holistic Health Assessment Tool for Patients on Maintenance Hemodialysis

Overview

Journal Indian J Nephrol

Specialty Nephrology

Date 2012 Nov 20

PMID 23162270

Authors

P R Singhania

S Mandalika

Affiliations

Soon will be listed here.

Abstract

The recent emphasis on assessment of the psychological status, availability of newer and better methods of interpreting the anthropometric measurements of renal patients on dialysis therapy prompted the authors to develop the "Holistic Health Assessment Tool for dialysis patients (HHAT-D)." A total of 30 subjects (25-65 years), enrolled from dialysis centers in Mumbai were administered the HHAT-D tool to assess anthropometric, biochemical, functional, and psychological status (knowledge, needs, that coping strategies) along with dietary intake. The results showed that majority of the patients (73.3%) were mild to moderately malnourished. A highly significant negative correlation of anthropometric measurements (BMI, lean body mass, mid arm circumference, arm muscle area, bicep skin fold thickness, % usual body weight, and % standard body weight) with the HHAT-D scores (P<0.01) confirmed the validity of the tool in assessing the degree of malnutrition. The poor health status of the patients was further confirmed by the average (40%) to poor (36.6%) flexibility status and poor dietary nutrient intake. Moderate (36.6%) to high (60%) coping effectiveness was recorded in the patients as assessed using the "coping effectiveness inventory." A high degree of interitem correlation (Cronbach's coefficient alpha-test value 0.836) also proved the reliability of the HHAT-D tool. Thus, the HHAT-D was found to be a specific and reliable tool for assessment of holistic health status of patients on maintenance hemodialysis to improve quality of life and facilitate faster recovery.

References

Steinman T . Serum albumin: its significance in patients with ESRD. Semin Dial. 2000; 13(6):404-8. DOI: 10.1046/j.1525-139x.2000.00110.x. View

Nascimento M, Qureshi A, Stenvinkel P, Pecoits-Filho R, Heimburger O, Cederholm T . Malnutrition and inflammation are associated with impaired pulmonary function in patients with chronic kidney disease. Nephrol Dial Transplant. 2004; 19(7):1823-8. DOI: 10.1093/ndt/gfh190. View

Taskapan H, Ates F, Kaya B, Emul M, Kaya M, Taskapan C . Psychiatric disorders and large interdialytic weight gain in patients on chronic haemodialysis. Nephrology (Carlton). 2005; 10(1):15-20. DOI: 10.1111/j.1440-1797.2005.00321.x. View

Detsky A, Baker J, Mendelson R, Wolman S, Wesson D, Jeejeebhoy K . Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. JPEN J Parenter Enteral Nutr. 1984; 8(2):153-9. DOI: 10.1177/0148607184008002153. View

Marckmann P . Nutritional status of patients on hemodialysis and peritoneal dialysis. Clin Nephrol. 1988; 29(2):75-8. View

Gupta D, Lammersfeld C, Vashi P, Burrows J, Lis C, Grutsch J . Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr. 2004; 59(1):35-40. DOI: 10.1038/sj.ejcn.1602029. View

Carney R, Wetzel R, Hagberg J, Goldberg A . The relationship between depression and aerobic capacity in hemodialysis patients. Psychosom Med. 1986; 48(1-2):143-7. DOI: 10.1097/00006842-198601000-00013. View

Singh A . The target hemoglobin in patients with chronic kidney disease. Nephrol News Issues. 2006; 20(13):29-30. View

Nissenson A, Strobos J . Iron deficiency in patients with renal failure. Kidney Int Suppl. 1999; 69:S18-21. DOI: 10.1046/j.1523-1755.1999.055suppl.69018.x. View

10.

Goldwasser P, Mittman N, Antignani A, Burrell D, Michel M, Collier J . Predictors of mortality in hemodialysis patients. J Am Soc Nephrol. 1993; 3(9):1613-22. DOI: 10.1681/ASN.V391613. View

11.

. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42(4 Suppl 3):S1-201. View

12.

Dwyer J, Cunniff P, Maroni B, Kopple J, Burrowes J, Powers S . The hemodialysis pilot study: nutrition program and participant characteristics at baseline. The HEMO Study Group. J Ren Nutr. 1998; 8(1):11-20. DOI: 10.1016/s1051-2276(98)90032-2. View

13.

Rojratsirikul C, Sangkhathat S, Patrapinyokul S . Application of subjective global assessment as a screening tool for malnutrition in pediatric surgical patients. J Med Assoc Thai. 2004; 87(8):939-46. View

14.

Baker J, Detsky A, Wesson D, Wolman S, Stewart S, Whitewell J . Nutritional assessment: a comparison of clinical judgement and objective measurements. N Engl J Med. 1982; 306(16):969-72. DOI: 10.1056/NEJM198204223061606. View

15.

Cianciaruso B, Brunori G, Kopple J, Traverso G, Panarello G, Enia G . Cross-sectional comparison of malnutrition in continuous ambulatory peritoneal dialysis and hemodialysis patients. Am J Kidney Dis. 1995; 26(3):475-86. DOI: 10.1016/0272-6386(95)90494-8. View

16.

Steiber A, Kalantar-Zadeh K, Secker D, McCarthy M, Sehgal A, McCann L . Subjective Global Assessment in chronic kidney disease: a review. J Ren Nutr. 2004; 14(4):191-200. View

17.

Kimmel P, Peterson R, Weihs K, Simmens S, Alleyne S, Cruz I . Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int. 2000; 57(5):2093-8. DOI: 10.1046/j.1523-1755.2000.00059.x. View

18.

Kalantar-Zadeh K, Kleiner M, Dunne E, Lee G, Luft F . A modified quantitative subjective global assessment of nutrition for dialysis patients. Nephrol Dial Transplant. 1999; 14(7):1732-8. DOI: 10.1093/ndt/14.7.1732. View

19.

Kakiya R, Shoji T, Tsujimoto Y, Tatsumi N, Hatsuda S, Shinohara K . Body fat mass and lean mass as predictors of survival in hemodialysis patients. Kidney Int. 2006; 70(3):549-56. DOI: 10.1038/sj.ki.5000331. View

20.

Yeh S, Chou H . Coping strategies and stressors in patients with hemodialysis. Psychosom Med. 2007; 69(2):182-90. DOI: 10.1097/PSY.0b013e318031cdcc. View