Malnutrition and inflammatory parameters in patients with chronic kidney disease stages 3–5 from northern India

Abstract
Background
Malnutrition is highly prevalent in chronic kidney disease (CKD). This study is conducted to find out the prevalence of malnutrition and its association with inflammation in patients with CKD stages 3–5.

Method
This is a hospital-based cross-sectional study conducted at the Sri Ram Murti Smarak Institute of Medical Science, Uttar Pradesh, India. CKD stages 3–5 patients were included. The nutritional status was assessed by subjective global assessment (SGA). Anthropometric and biochemical measurements were also checked at the time of enrollment.

Results
A total of 213/354 (60.2%) of patients were malnourished. The triceps skinfold thickness (TSFT) was 8.2 ± 1.2 mm and 10.9 ± 1.2 mm in the malnourished and well-nourished groups, respectively; p < 0.001. TSFT was ≤ 10 mm in 91.1% of patients with malnutrition. Mid-arm muscle circumference (MAMC) was 21.3 ± 2.2 cm and 24 ± 2.9 cm, and the body mass index (BMI) was 19.8 ± 1.5 and 22.5 ± 1.4 kg/m2 in the malnourished and well-nourished group, respectively; p < 0.001. A significant direct correlation between BMI, TSFT, MAMC, and eGFR was noted. Median eGFR was 11.9 ml/min/1.73 m2 in the malnourished compared to 24.2 ml/min/1.73 m2 in the well-nourished group; p < 0.001. Serum ferritin level was 246.77 ± 18.24 mg/L in the malnourished group, higher than the well-nourished group at 237.23 ± 16.13 mg/L; p < 0.001. CRP was elevated (> 0.6 mg/dl) in 53.5% patients with malnutrition; p 0.003.

Conclusions
Malnutrition is highly prevalent in the CKD population. The incidence increases as the eGFR decrease. TSFT ≤ 10 mm compares favorably with SGA in detecting malnutrition (sensitivity > 90%), and BMI > 20 kg/m2 compares favorably with SGA in ruling out malnutrition (specificity 97%). Malnutrition and inflammation often coexist. Early detection and appropriate management are crucial.