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Background and objectives: Protein-energy malnutrition (PEM) is common in hemodialysis patients. So far, no comprehensive study has been performed on prevalence of PEM in various areas of Iran, including Tehran with the largest number of hemodialysis patients in the country. Furthermore, according to the available literature, there is no report on prevalence of various types of PEM in hemodialysis patients. Therefore, the present study was designed to investigate prevalence of PEM and its various types in Tehran hemodialysis patients in 2008. Materials and methods: In this cross-sectional study, using systematic sampling, 291 hemodialysis patients were randomly selected from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was determined by subjective global assessment (SGA) and their dietary intakes were assessed using a 4-day dietary recall (2 dialysis and 2 non-dialysis days). At the end of the first dialysis session, patients' heights and weights were recorded. Finally, after a 12- to 14- hour fast, 4 mL of blood were obtained from each patient before dialysis and analyzed for the serum urea, creatinine, albumin and CRP. Results: The prevalence of mild-to-moderate and severe PEM based on SGA was 60.5% and 1% in Tehran hemodialysis patients, respectively. The distribution of the malnourished hemodialysis patients according to type of PEM was as follows: 20.5%, type I (inadequate energy or protein intake, without inflammation) 65.5%, type IIa (inadequate energy or protein intake, with inflammation) and 14% type IIb (adequate energy and protein intake, with inflammation). The distribution of those hemodialysis patients who did not suffer from PEM was as follows: 3.5%, type Ia normal nutritional status (adequate energy and protein intake, without inflammation) 34% type Ib normal nutritional status (inadequate energy or protein intake, without inflammation) 55.5% type IIa normal nutritional status (inadequate energy or protein intake, with inflammation) and 7% type IIb normal nutritional status (adequate energy and protein intake, with inflammation). Conclusion: The results of the present study indicate that PEM in Tehran hemodialysis patients is considerably prevalent and type IIa is the most common type. In addition, hemodialysis patients with no PEM based on SGA should also be paid attention to because they may have inadequate intake‎ of energy and/or protein and inflammation. Keywords: Subjective global assessment, Protein-energy malnutrition, Inflammation, Hemodialysis

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Background and Objectives: Protein-energy malnutrition (PEM) is prevalent among hemodialysis patients. So far, no study has compared various methods for determination of PEM, including subjective global assessment (SGA), dialysis malnutrition score (DMS), malnutrition inflammation score (MIS), and body mass index (BMI), in hemodialysis patients. The present study was designed to determine sensitivity, specificity, accuracy, positive and negative predictive values, as well as positive and negative likelihood ratios of DMS, MIS and BMI in comparison with SGA as the most common method for determination of PEM inhemodialysis patients. Subject and Methods: A total of 291 hemodialysis patients were randomly selected by systematic sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was assessed by completing SGA, DMS and MIS forms and determining BMI. In addition, after a 12- to 14-hour fast, 4-mL blood samples were obtained from each patient before dialysis for measurement of serum urea, creatinine, albumin and total iron binding capacity. Results: Based on SGA, DMS, MIS, and BMI, the prevalence of mild-to-moderate PEM in Tehrani hemodialysis patients was, respectively, 60.5%, 61.5%, 54%, and 16.5%, and that of severe PEM 1%, 1.5%, 1%, and 1%. In comparison with SGA, the sensitivity, specificity, accuracy, area under the receiver operating characteristic (ROC) curve, positive and negative predictive values, and positive and negative likelihood ratios were, respectively, 94%, 88%, 92%, 97%, 93%, 92%, 7.8, and 0.07 for DMS 87%, 96%, 91%, 97%, 97%, 83%, 22.0, and 0.13 for MIS and 23%, 91%, 50%, 64%, 80%, 43%, 2.5, and 0.85 for BMI. Conclusion: The results of the present study indicate that the DMS and MIS are almost similar to SGA, in identifying malnutrition in hemodialysis patients, while BMI is not an appropriate index in this regard. In addition, it appears that the DMS is a more appropriate alternative method for SGA in routine hospital assessments. Keywords: Protein-energy malnutrition, Hemodialysis, Subjective global assessment, Dialysis malnutrition score, Malnutrition inflammation score

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Background and Objective: The risk of cardiovascular diseases among hemodialysis patients with energy-protein malnutrition (PEM) is higher compared to well-nourished hemodialysis patients. Traditional risk factors for cardiovascular diseases such as a high body mass index and serum total cholesterol cannot explain the high prevalence of cardiovascular diseases in hemodialysis patients with PEM. Therefore, the present study was designed to study the association of PEM with nontraditional risk factors of cardiovascular diseases in hemodialysis patients. Materials and Methods: A total of 291 hemodialysis patients were selected with systematic randoml sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was determined by subjective global assessment (SGA). In addition, dialysis malnutrition score (DMS) and malnutrition inflammation score (MIS) of the patients were determined and their dietary intakes assessed using a 4-day dietary recall including 2 dialysis days and 2 non-dialysis days. Also, after a 12- to 14-hour fast, an 8 mL- sample of blood was taken from each patient before dialysis and serum urea, creatinine, albumin, CRP, sICAM-1, sVCAM-1, sE-selectin, MDA, NO, endothelin-1, and Lp(a) were measured. Results: The serum concentrations of CRP and sICAM-1 were significantly higher in hemodialysis patients with PEM as compared to those without PEM (p<0.01), whereas there were no significant differences in serum concentrations of sVCAM-1, sE-selectin, MDA, NO, endothelin-1 or Lp(a) between the two groups. In addition, compared to hemodialysis patients with PEM types IIa or IIb, those with PEM type I had significantly lower serum CRP and sICAM-1 levels (p <0.01). There were significant direct correlations between DMS and MIS, as two PEM indicators, with serum CRP and sICAM-1 (P <0.01). Conclusion: The results of the present study indicate that nontraditional risk factors of cardiovascular diseases do not increase in hemodialysis patients with PEM type I, whereas serum CRP and sICAM-1, two risk factors of cardiovascular diseases, increase in PEM type II, which is accompanied with inflammation. Keywords: Protein-energy malnutrition, Hemodialysis, Cardiovascular risk factors