Impact of malnutrition on the effectiveness of rehabilitation in hospitalized patients undergoing hemodialysis: a comparison with non-dialysis patients.

Hiroki Yabe, Takashi Hibino, Akio Suzumura, Ren Takahashi, Hideaki Ishikawa, Tetsuya Yamada
Purpose:

To determine the impact of rehabilitation on the improvement of ADL and physical function for hospitalized HD patients with malnutrition compared to non-dialysis patients.

Methods:

Patients undergoing rehabilitation after acute care from April 2017 to February 2023 were included in this study. Malnutrition was defined as a Geriatric Nutrition Risk Index (GNRI) score of less than 91.2. Subjects were categorized into 4 groups based on malnutrition status and presence of HD; non-HD with malnutrition group, HD with malnutrition group, non-HD without malnutrition group, and HD without malnutrition group. Outcomes, including Barthel Index (BI), grip strength, Isometric knee extension strength (IKES), Timed Up and Go test (TUG), and 10-meter walking speed (10MWS), were measured at admission and discharge. A linear mixed model was employed for statistical analysis, comparing pre/post-rehabilitation improvements (Δ) and between-group differences (ΔDifferent). A significance level of 0.05 was set.

Results:

A total of 848 subjects were included (non-HD with malnutrition group: n=452, HD with malnutrition group: n=110, non-HD without malnutrition group: n=275, HD without malnutrition group: n=11). The prevalence of malnutrition was 62.2% in the entire non-HD group and 90.9% in the HD group. In a pre/post comparison, both the non-HD with malnutrition group and the non-HD without malnutrition group showed significant improvement in all outcomes. The HD without malnutrition group demonstrated significant improvements in BI (Δ: 14.7 [7.9 to 21.5] points) and TUG (Δ: -10.8 [-18.2 to -3.3] seconds), but no improvements were observed in other variables. The HD with malnutrition group exhibited significant changes in BI (Δ: 12.2 [8.3 to 16.1] points), IKES (Δ: 3.2 [0.9 to 5.6]%), and 10MWS (Δ: 0.07 [0.01 to 0.14] m/s), with no improvements in other variables. Comparisons between groups showed no significant differences in all outcomes between the non-HD without malnutrition group and the HD without malnutrition group. However, the HD with malnutrition group showed significantly smaller improvement in 10MWS (ΔDifference: -0.11 [-0.18 to -0.04] m/s, P0.05) compared to the non-HD with malnutrition group.

Conclusion(s):

This study found that hospitalized HD patients are more affected by malnutrition than non-HD patients with the same malnutrition status in terms of improvement in walking function.

Implications:

Hospitalized HD patients are highly affected by malnutrition, emphasizing the need for rehabilitation based on appropriate assessment of nutritional status. Furthermore, it is important for hospitalized HD patients with malnutrition to receive enhanced nutritional therapy and rehabilitation in parallel, in cooperation with a dietician.

Funding acknowledgements:
The authors did not receive support from any organization for the Study.
Keywords:
Hemodialysis
malnutrition
Rehabilitation
Primary topic:
Disability and rehabilitation
Second topic:
Community based rehabilitation
Third topic:
Other
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Ethical Committee of Nagoya Kyoritsu Hospital.
Provide the ethics approval number:
K141-01
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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