





































Clinical Medicine Insights
Received 15 Feb 2022 | Revised 18 Feb 2022 | Accepted 23 Feb 2022 | Published Online 26 Feb 2022

DOI: https://doi.org/10.52845/CMI/2022-3-1-4
CMI 03 (01), 268−277 (2022) ISSN (O) 2694-4626 

RESEARCH ARTICLE

Study of the nutritional status of end-stage renal disease patients on
maintenance hemodialysis in Hawary Kidney center and nephrology unit at
Benghazi Medical Center

Safia S. Elramli
1Assistant Professor, Nutrition
department, faculty of Public
Health, University of Benghazi)
Afaf Omer Sati, Ebtesam Mostafa
, Norhan Elhassi( Public Health
Students

Abstract
Background: Malnutrition, which is a powerful predictor of morbidity and mortality, is 
common in patients undergoing hemodialysis. There-fore, adequate nutrition is very 
important for such patients. Nutritional management in hemodialysis patients is a very 
important factor for prognosis , a better overall outcome and quality of life.
Objectives: The current study mainly aimed to determine the nutritional status and prevalence of 
malnutrition and to investigate the relationship between nutritional markers, anthropometric 
parameters such as body mass index (BMI), and routine laboratory parameters with SGA 
in patients undergoing hemodialysis.
Patients and Methods: A cross-sectional study was carried out on HD patients in 
Hawari Nephro Center and Nephro Unit of Beng-hazi Medical Center from December 
2019 to January 2020. A total of 155 HD patients were recruited for this study and 
assessed for nutritional status include both Male and females aged 18 years and over 
with regular hemodialysis. Outcome measures: Measurements included questionnaire that 
elicited information on social demographic characteristics, Patient’s medical history , and 
duration of hemodialysis. Anthropometry, biochemical parameters were measured. Seven-
Point Subjective Global Assessment (7-point SGA) was used to assess the nutritional state 
of HD patients. Biochemical tests were obtained during the study period from medical files of 
the studied patients. Data were analyzed using descriptive statistics. The Chi-Square test 
was applied to examine the study data.
Results: Data shows that 58% of HDP were well-nourished while the remaining 39%, 
3%had mild-to-severe malnutrition. Regarding the prevalence of malnutrition in both gender, 
males group was mor preva-lent of malnourished than female group. SGA score results 
indicated some significant correlations with patient’s post dialysis BMI and albu-
min ,however, there was a negative correlation between demographic characteristics as 
gender, income, education level, comorbid disease , clinical variable such as duration 
and frequency of HD and some biochemical tests as electrolytes, phosphorous ,hemoglobin, 
cholesterolwith SGA scores. In addition,  results  show that  insignificant correlation between 
nutrients intake, meals pattern of  HD patients  with SGA.
Conclusions: Observations of nutritional status are necessary to maintain the health status of 
dialysis patients. Every strategy should be used to avoid complications of  hemodialysis  
manifested in uremic state including anorexia, nausea, vomiting leading to malnutrition, fluid 
and electrolyte imbalance leading to volume overload, hyperkalemia, metabolic acidosis, and 
hyperphosphatemia, as well as abnormalities related to hormonal or systemic dysfunction 
such as hypertension, anemia, hyperlipidemia, and  bone disease, Timely diagnosis of protein-
energy-wasting (PEW) is important for early initiation of nutritional intervention and 
treatment. In addition, education plans should be prepared to mediate the nutrient intakes and 
identify the patient's difficulties and provide practical help.

Keywords: Renal dialysis, Nutritional status, Hemodialysis, Malnutrition

MANUSCRIPT CENTRAL

used to avoid complications of hemodialysis manifested in uremic
state including anorexia, nausea, vomiting leading to malnutrition, fluid
and electrolyte imbalance leading to volume overload, hyperkalemia,
metabolic acidosis, and hyperphosphatemia, as well as abnormalities
related to hormonal or systemic dysfunction such as hypertension,
anemia, hyperlipidemia, and bone disease, Timely diagnosis of protein-
energy-wasting (PEW) is important for early initiation of nutritional
intervention and treatment. In addition, education plans should be
prepared to mediate the nutrient intakes and identify the patient’s
difficulties and provide practical help.
Keywords: Renal dialysis, Nutritional status, Hemodialysis, Malnutri-
tion

Copyright : © 2022 The Authors. Published by Publisher. This is an
open access article under the CC BY-NC-ND license
(https://creativecommons.org/licenses/by-nc-nd/4.0/).

CMI 03 (01), 268−277 268

https://doi.org/10.52845/CMI/2022-3-1-4
https://creativecommons.org/licenses/by-nc-nd/4.0/


1 INTRODUCTION

One expanding global public health challenge
is chronic kidney disease (CKD) , which
is manifested by an irreversible deteriora-

tion of kidney function that may eventually lead to
end-stage renal disease (ESRD) and require renal
replacement therapy such as renal transplantation or
hemodialysis (HD) [1]. The main aim of HD is to
rebalance the intracellular and extracellular fluid vol-
ume that is a characteristic function of normal kid-
neys. This is performed by transporting solutes (i.e.
urea) from the blood to the dialysate and by trans-
porting solutes (i.e. bicarbonate) from the dialysate
to the blood [1].
kidney dysfunction is associated with defects in
acid excretion, systemic inflammation, end-organ
hormone resistance and uremic toxin accumulation.
These abnormalities can further worsen kidney func-
tion, creating a vicious circle, adversely affect pa-
tients’ outcome[2].

2 CAUSES OF NUTRITIONAL DISORDER
IN HD

2.1 Inadequate food intake

In dialysis patients, the decrease in food intake is
a major cause of PEW and mortality [3]. Multi-
ple factors have been implicated .Major causes of
feeding restriction are comorbidities mainly cardio-
vascular disease and history of volume overload ,
hospitalizations, depression, low social status, di-
etary restrictions , multiple medical treatments, and
accumulation of uremic toxic molecule[3]

2.2 Abnormal nutrient metabolism

Energymetabolism:Most studies on resting energy
expenditure (REE) measurements in HD and PD pa-
tients reported REE values similar to that of controls
[4]. In two studies, REE was found to be increased
[3], and in one study in malnourished HD patients,
REE was found to be decreased [4]. Regarding the
determinants of REE, it was shown that severe hy-
perparathyroidism , elevated serum CRP and serum

IL-6 were associated with increased REE.

Amino acid and protein metabolism: In HD pa-
tients, plasma concentrations of amino acids( AAs)
are characterized by a relative decrease in plasma
serine and essential AAs except methionine, and an
increase in citrulline and aspartate . Tyrosine and
histidine are considered as essential AAs in renal
failure [5]. These disturbances of plasma AAs during
chronic kidney disease ( CKD) have been attributed
to the abnormal handling of AAs not only in the
kidneys but also in the hepatosplanchnic area[5].
Protein-energy malnutrition is a common problem
among patients on hemodialysis (HD). Malnutrition
can occur in up to 40% of the patients with renal
failure and is associated with increased mortality
and morbidity. Therefore, management of the nutri-
tional aspects of patients with chronic kidney disease
(CKD) presents a number of challenges [6].
In hemodialysis patients (HDP), it is important to
perform an early diagnosis of malnutrition (MN)
and inflammation, which are represented by protein-
energy wasting (PEW) as they are significant pre-
dictors of mortality , using the best clinically avail-
able tools to create specific nutritional strategies
that can predict outcomes, evaluate therapeutic re-
sponses, and avoid severe nutritional deterioration
[7]. This adds to the importance and significance of
the presence of nutrition specialists in HD center for
early detection of malnutrition and strategies to be
implemented to prevent further deterioration [8].
The pathogenesis of malnutrition in dialysis pa-
tients
The causes of both malnutrition and inflammation
are numerous in chronic renal injury ( CRI )patients
with elevated serum levels of C-reactive protein(
CRP) and pro-inflammatory cytokines. Patients may
not ingest sufficient amounts of food because of
loss of appetite. Anorexia can be caused by factors
such as the retention of uraemic toxins and chronic
metabolic acidosis, which, moreover, is an important

Supplementary information The online version
of this article (10.52845/CMI/2022-3-1-4) contains
supplementary material, which is available to autho-
rized users.

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catabolic factor [9]. In this regard, inadequacy of
dialysis treatment may be an important cause of mal-
nutrition. Renal replacement therapy per se causes
a loss of nutrients. During a hemodialysis (HD)
session, a considerable quantity of amino acids may
be lost (4–9 g in the fasting state and 8–12 g post-
prandially). In contrast, protein losses are negligible,
unless multiple re-use of dialysis filters is practiced.
HD can cause a loss of vitamins, particularly water-
soluble vitamins. Endocrine and metabolic distur-
bances of uremia, in particular insulin resistance, can
reduce protein anabolism and favor catabolism. The
role of psychological factors (depression) and socio-
economic factors (loneliness, invalidity, poverty)
should never be neglected, considering that at present
the majority of the dialysis population is composed
of elderly patients [9]. Acute concurrent illnesses can
also contribute to malnutrition. Finally, inadequate
dietary prescription, due to the traditional physi-
cian’s preference of prescribing nutritional restric-
tion rather than providing nutritional counselling,
can further worsen malnutrition [9].The pathogen-
esis of chronic systemic inflammation in dialysis
patients, which is associated with hyper catabolism
and bodywasting, is complex and not yet fully under-
stood. Other non-dialysis related causes of elevated
CRP include co-morbid conditions, e.g. chronic heart
failure with edema and the atherosclerotic process
[10]. Moreover, various chronic infections, such as
Chlamydia pneumoniae and dental or gingival in-
fections may also contribute [10]. Furthermore, it
has been suggested that factors related to the dial-
ysis procedure itself may contribute to maintaining
chronic systemic inflammation. In order to prevent
and treat malnutrition in dialysis patients, it is im-
portant to assess appropriately the nutritional status
and to identify patients at risk [10].
Methods to assess nutritional status in dialysis
patients
There is a single best nutritional marker in patients
with CRI, but that several nutritional markers should
be evaluated together. The assessment of nutritional
status should be based on a combination of clin-
ical parameters with biophysical and biochemical
parameters[11]. Malnourished dialysis patients often
have protein energy malnutrition with a reduction
of both fat mass (FM) and lean body mass (LBM).

Therefore, clinical assessment of subcutaneous FM
and muscle mass and a history of weight loss are
important parts of routine nutritional assessment.
Percentage of standard weight and body mass index
(BMI) are also important and easy to measure, al-
though BMI is more useful for assessment of obesity
than of malnutrition.Most dialysis patients with mal-
nutrition also have co-morbid diseases, in particular
cardiovascular disease and inflammation, and the
assessment of co-morbid conditions is an important
part of the nutritional assessment of dialysis patients
[11]. Laboratory parameters used in clinical routine,
such as proteins, serum levels of C-reactive protein
(CRP) and lipid profile may be influenced in HD
patients by the inflammatory condition [11]. Fur-
thermore, it should be noted that other parameters,
such as serum cholesterol concentration, experience
a reverse epidemiology in patients onHD. However,
both serum prealbumin levels in early stages of mal-
nutrition and those of albumin (much later) are good
nutritional markers [12]. During recent years, sub-
jective global assessment of nutritional status (SGA)
has been used increasingly to assess nutritional status
in many studies of dialysis patients (mainly cross-
sectional studies) and in patients with CRI at start
of dialysis therapy [13]. SGA correlates well with
other nutritional markers in patients with CRI .Fur-
thermore, it has a high predictive value for mortality
in these patient groups . However, one potential
problem with SGA is its subjective nature, which
may reduce its reproducibility, thus small differences
in SGA score must be interpreted with great caution
[13].

3 AIM AND OBJECTIVES

The aim of this study was to study the prevalence of
malnutrition among hemodialysis patients.
Objectives
1.To determine the prevalence of nutritional disor-
ders (malnutrition, anemia, hypernatremia, hyper-
kalemia, and hyperphosphatemia)
2.To show the association between nutritional status
and regular hemodialysis in both gender

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3.To identify the effects of demographic character-
istics, chronic disease of HD patients on nutritional 
status
34To find out wither the frequency and duration of
dialysis session per week are effect on nutritional
status of HD patients
5.To determine whether nutritional status decline
over time in patients receiving dialysis

4 METHODOLOGY

Design:
It was cross-sectional study random sample con-
ducted at Nephrology unit of BenghaziMedical Cen-
tre and Hawari Nephrology Center – Libya, to deter-
mine the nutritional status of end-stage renal disease
patients on maintenance hemodialysis aged from 18
to 83 years old. The access to this study was ob-
tained following ethical approval after consultation
with and permission of local medical research ethics
committee, senior management, and site managers
at Benghazi Medical Centre and Howari Nephrology
Center. Total sample was 155 patients includes both
Male and females aged 18 years and over with regu-
lar hemodialysis .
Criteria for inclusion the study
The target of study consisted of patients with ESRF
with maintenance hemodialysis both male and fe-
male with Libyan nationality. All enrolled patients
should have completed a minimum of three months
duration on HD
Exclusion criteria:
Patients had acute renal failure on hemodialysis , any
patient with chronic renal failure or end stage renal
failure did not start of hemodialysis , as well as pa-
tients on temporary hemodialysis due to other cause
than renal failure. Patients who were hospitalized
for more than two weeks for a non-vascular access
complication or had signs of active infection were
excluded from the study
Patients from other nationality other than Libyan
nationality or patients younger than 18 years old
were excluded.

Procedure and materials:The study will be carried
out over 2 months period from December 2019
to January 2020 and included 155 patients with a
mean age of 47.8 ; there were 92(59.4%) males and
63(40.6%) females .
The researcher will seek approval to conduct the
study and to discuss access with site mangers. Re-
searchers should be set to meet with participants to
discuss the study, obtaining an informed consent,
measurements, and data collections. Researchers
were set to meet with participants, the study was ex-
plained, and an informed consent obtained. A com-
plete social and medical history , including details
of the patient’s diet using 24 hours recall method
and food frequency questionnaire , physical exam-
ination, and recording of the dry body weight was
performed to calculate BMI . Biochemical tests were
obtained during the study period from medical files
of the studied patients. The baseline laboratory tests
included serum hemoglobin ,serum albumin, [total
cholesterol, serum creatinine, CRP, serum potassium
,sodium, calcium and phosphorus, and serum urea
nitrogen.
Assessment of nutritional status
As no single measure predicts overall nutritional sta-
tus in patients with HD, amultidimensional approach
has been proposed to include measurement of body
composition, dietary intake, biochemical measures
and muscle strength . However, this is clearly not
practical for all patients in routine clinical practice
and therefore the use of nutritional screening tools,
such as Subjective Global Assessment (SGA) which
incorporates important measures such as body mass
index should be applied to the general HD patients
to identify patients at risk of malnutrition. Selected
patients should then undergo more detailed assess-
ment, including dietary intake, anthropometric eval-
uation and measurement of laboratory investigation.
Serum albumin level and body mass index (BMI)
were the most predictive parameters of malnutrition
[14]. However, the nutritional status of patients was
assessed by extensive anthropometric measurements
.Whereas the biochemical markers of nutrition such
as serum albumin, S. creatinine, CRP ,S. cholesterol
was unavailable for most patients as well as the
detection of malnutrition can be problematic in HD

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SAFIA S. ELRAMLI

patients as the body weight is influenced by fluid
status and biochemical markers such as albumin,
CRP and haemoglobin are affected by the disease
process. In clinical practice, Therefore review of
the patients albumin level, and body weight include
recent changes and their dietary intake is approve
helpful [14].

5 RESULT

The aim of this study was to assessment the nutri-
tional status and prevalence of malnutrition among
hemodialysis patients in Howari Nephrology Center
and Nephrology Unit of BMC Hospital in Benghazi.
1.DESCRIPTION OF STUDY PARTICIPAM-
NTS
The background characteristics of the participants
are summarized in Table (4.1.and 4.2)
A total of 155 HD patients in this study were re-
cruited for the study, the age ranges was between
(18-83 years), the mean age was 47.48 , included 92
males and 63 females
Table (4.1)distribution of age

2. Demographic characteristicand clinical infor-
mation of the studied patients
All participants enrolment in this study were on
regular dialysis. approximately 23.9% did not earn
an income (either unemployed or a housewife), and
Most patients (29% )had a monthly income of 500-
1000dinner ,while only 7% had income ,1500 dinner
as shows in table(4.3)

Regarding the patient’s educational level, 
approximately 54.2% ,whereas 45.2% were 
illiterates as demonstrated in  table(4.3)
clinical information of the studied patients is 
presented in table(4,3) . most (56.8%) of studied 
HD patients reported that they have been do 
surgeries  ,however, about 43,2% they do not.  
Table (4,3)  demonstrated that   the highest percent  
of participants were have family history for chronic 
disease  which was 60% ,while only 40% did not 
found history of chronic disease. and 
approximately 72% of the studied patients reported 
did not having  family history of renal disease , 
only 27.3 confirmed with family history of renal 
disease. Comorbid conditions in the study patients 
were mainly hypertension (HTN)94 (60.6%) 
followed by diabetes mellitus (DM) 23(14.8%). A 
bout 23 (14.8% ) of the patients had both DM and 
HTN. Overall, 13(8.4%)of HD patients did not  
have  any  comorbid condition.

Table(4,3) Demographic characteristic and 
clinical information of participants

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Table(4.2) distribution of gender



Subjective Global Assessment (SGA) score that was
originally developed to assess post-operative nutri-
tional state and is one of the methods suggested to
assess nutritional status in HD patients. The SGA
was suggested by the National Kidney Foundation
and has undergone several modifications . The SGA
comprises of five criteria, and includes medical his-
tory, physical examination, subcutaneous fat, muscle
wasting and fluid retention. A score A indicated well
nourished , score B mildly to moderately malnour-
ished ,score C severely malnourished .
The nutritional status of the patients indicated that
(58%) were well-nourished while the remaining
(39%, 3%) had mild-to-severe malnutrition [Figure
4,1] below.

(figure 4.1) Prevalence of malnutrition among HD
patients

6.2 Body mass index in the study pa ents

Regarding the patient’s post dialysis BMI 43.3%
were had normal BMI , 28.4% were overweight
,while 16.1%,7.1%,1.9% were grad1,2,and 3 obese
respectively . however, 4.5% appeared to be under
weight . The figure (4.2)shows all previously men-
tioned.

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6 ASSESSMENT OF NUTRITIONAL
STATUS OF HD. PATIENTS

6.1 Prevalence of malnutri on using
Subjec ve Global Assessment



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SAFIA S. ELRAMLI

Figure (4.2)Post- dialysis BMI of study patients

6.3 BMI and SGA score

Based on the results (table4.4 ) there was showed the
post dialysis BMI had a highly significant associa-
tion with SGA scores { P-value 0.29}.
Table (4,4) correlation between post-dialysis BMI 
and SGA

3.4. frequency of dialysis : Based on the results (ta-
ble 4,14)there was no association between frequency
of dialysis and SGA
(P value-0.578).

6.4 laboratory inves ga on

Result revealed that hemoglobin level regarding both
sex , the mean level of HBG among male group
was 9.9ml/dl as well as the minimum level was
5.4ml/dl while the maximum level was 16.8ml/dl.
About female group the mean HBG level was 9.5
while the maximum and minimum HBG level was
13.3 ml/dl and 9.5 respectively.
Table (4,6) Hemoglobin level among gender

Table(4,7) laboratory result among both sex

Regarding biochemical indexes of nutritional status
the table below(4,7) shows that the maximum and
minimum level of serum cholesterol among male
group was 198 ml/dl and 160ml/dl, whereas the
maximum and minimum level among female group
was 254ml/dl and 170 respectively
We noted that all patients in our sample had hyperc-
holesterolemia compared with normal level ,whereas
urine albumin was high at maximum level in both
groups. High loss of albumin in urine is marker of
malnutrition.
Table(4,7) serum cholesterol-albumin in both sex

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Correlation between SGA score and 
biochemical tests

Correlational analysis was carried out between SGA
scores and laboratory results correlation (Table4,8)
No significant correlation was found between SGA
score and potassium level (P = 0.889), sodium level
(P = 0.400), hemoglobin (P = 0.706),cholesterol
level(p=0.764) and phosphate level (P = 0.562).
However, significant positive correlation was found
between SGA core and albumin level (P = 0.031).
Table(4,8) Correlation between SGA and biochemi-
cal test

6.5 Associa on between nutrient intake and
SGA

Table 4.9 below shows the association between nutri-
ents intake among HD patients and SGA parameters,
based on result was showed a negative correlation
, the correlation between SGA scores and protein
(p =0.652),calorie (p=0.998),CHO(p=0.575),and
fat(p=0.932).
Table (4,9) ): Association between SGA scores and
daily nutrient intake

7 DISCUSSION

In this study, we aimed to estimate the nutritional
status of a sample of HD patients and potential
significant predictors of nutritional status among the
studied patients. Nutritional status is an important
predictor of outcome in ESRD patients on main-
tenance HD. Assessment of the nutritional status
needs a systematic nutritional evaluation based on
anthropometric, laboratory, and clinical parameters
from which a malnutrition score can be calculated.
With regard to association between BMI and SGA
score our result illustrated that 43.3% HD patients
post dialysis BMI were had normal and most of
them were well-nourished, while patients with un-
derweight were severely malnourished. In addition,
the result demonstrated that there was showed post
dialysis BMI had a highly significant association
with SGA scores with P-value 0.29. Similarly, study
done by Ekramzade et al. reported that HDPwithMN
had a lower BMI than well-nourished patients [15].

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SAFIA S. ELRAMLI

Another study was done by . Mohammed (2014)
convinced that post dialysis BMI had high significant
association with SGA [16]
On the other hand, our results disagreed with
the study of Ghali and Malik,[17 ] there was no
significant effect of post dialysis BMI and SGA
. About frequency of dialysis , In present study
most of participants in our sample were dialysis
for 3 times a week was well nourished while
the rest of them were mildly malnourished and
five patients had sever malnourished among those
patients also the result showed that frequency of
hemodialysis non-significant correlation with SGA.
However, study was done by Bohé and Rennie
(2006) [18]provided a significant analysis and
discussion on the subject and reported that patients
receiving dialysis three times a week lost 2 kg of
lean body mass in a year [18]. Some other studies
also found severity of malnourished increased with
increased dialysis frequency [19]. As demonstrated
in our result, the correlation between SGA scores and
laboratory results were No significant was found
with potassium level (P = 0.889), sodium level
(P = 0.400), hemoglobin (P = 0.706),cholesterol
level(p=0.764) and phosphate level (P = 0.562).
However, significant positive correlation was found
between SGA core and albumin level. In contrast
other study by Stosovic etal (2011) have previously
found that SGA score was significantly correlated
with Hb level but not with albumin level or any
other biochemical indicator[20]. The evident poor
intake of high quality protein also reported in present
study. In this study we also found that the association
between nutrients intake among HD patients
and SGA parameters was a negative correlation.
The correlation between SGA scores and protein
(p =0.652),calorie. (p=0.998),CHO(p=0.575),and
fat(p=0.932). poor protein and energy intake,
comorbidities and inflammation were the predictors
of MN in descending order of importance [21].
Morais et al. performed a prospective study to
investigate the association between nutritional status
and food intake in HDP and the authors reported that
nutrients intakes had a significant correlation with
subjective global assessment, which was different
to our findings reported here [22]. Study was done
by Therrien etal (2015) [23] were analyzed nutrient

intake of the subjects and found out that calorie and
protein intakes were insufficient compared to the
dietary intakes recommended for dialysis patients.

8 CONCLUSIONS

We conclude that the majority of our dialysis pa-
tients were well nourished, and followed by mildly
malnourished. Poor dietary knowledge and practices
were encountered among these patients with poor
biochemical parameters among the majority of them.
this study showed the majority of patients reported a
lower than recommended energy and protein intake
The SGA score results indicated that MN was mod-
erately prevalent among patients undergoing HD.
These results show some significant correlations be-
tween the nutritional status and patient characteris-
tics (i.e. post dialysis BMI and biochemical tests as
albumin ) , However , our result shows that HDP had
un-significant relation between demographic char-
acteristics , clinical variable and some biochemical
tests such as gender, income, education level, co-
morbid disease , and frequency of HD , electrolytes,
phosphorous ,hemoglobin, cholesterol with SGA
scores. We also found that a negative correlation
between nutrients intake among HD patients with
SGA parameters. Therefore, these findings should
increase the awareness of healthcare providers for
interventions to enhance the nutritional status for
HDP, especially those who are elderly, have multiple
comorbid diseases, , have a long dialysis vintage or
live alone. Consequently, efficient screening in HDP
for risk factors of MN and simultaneously perform-
ing a nutritional evaluation and assessment whenever
possible should facilitate early dietary intervention to
avoid further deterioration and nutritional depletion.
Further interventional studies should be conducted in
different nephrology center in Benghazi and with a
larger sample size to repeat these results so that they
are proven with greater certainty.

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CMI 03 (01), 268−277 (2022) MANUSCRIPT CENTRAL 276



MANUSCRIPT CENTRAL
SAFIA S. ELRAMLI

How to cite this article: S.S.E. Study of
the nutritional status of end-stage renal dis-
ease patients on maintenance hemodialysis
in Hawary Kidney center and nephrology
unit at Benghazi Medical Center . Clinical
Medicine Insights. 2022;268−277. https://doi.or
g/10.52845/CMI/2022-3-1-4

MANUSCRIPT CENTRAL CMI 03 (01), 268−277 (2022) 277


	Introduction
	Causes of nutritional disorder in HD
	Inadequate food intake
	Abnormal nutrient metabolism

	Aim and objectives
	Methodology
	Result 
	Assessment of nutritional status of HD. patients
	Prevalence of malnutrition using Subjective Global Assessment
	Body mass index in the study patients
	BMI and SGA score 
	 laboratory investigation 
	Association between nutrient intake and SGA

	Discussion
	Conclusions
	References



