Eduvest – Journal of Universal Studies Volume 4 Number 10, October,
2024 p- ISSN 2775-3735- e-ISSN 2775-3727 |
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ANALYSIS OF NUTRITIONAL STATUS, BODY COMPOSITION, AND CREATININE LEVELS
IN HEMODIALYSIS PATIENTS AT IBNU SINA YW-UMI HOSPITAL MAKASSAR |
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Nurul Zachristi S.Y1,
Zulfitriani Murfat2, Rahmawati3,
Aryanti R Bamahry4, Abdul Mubdi Ardiansar Arifuddin Karim5 1,2,3,4,5Faculty
of Medicine, Universitas
Muslim Indonesia, Indonesia Email: [email protected]1,
[email protected]2*, [email protected]3, [email protected]4,
[email protected]5 |
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ABSTRACT |
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Hemodialysis is an essential
therapy for managing chronic kidney failure, helping to maintain
homeostasis by removing excess fluids, solutes, and toxins from the
body. The global increase
in the prevalence of chronic kidney
disease (CKD) has led to a rising demand
for hemodialysis. This study aims to analyze the
relationship between nutritional status, body composition, and creatinine levels in hemodialysis patients at Ibnu Sina YW-UMI Makassar Hospital. Using an observational
cross-sectional design, the study involved 16 patients whose body mass index
(BMI), muscle mass, fat mass, total body fluid, and
visceral fat were measured before and after dialysis.
The results revealed significant changes in nutritional status, body composition, and creatinine levels pre- and post-hemodialysis,
analyzed through paired T-tests at a 0.05 confidence level. Most patients were male, aged over 45, with normal nutritional status but abnormal
creatinine levels. Body composition analysis showed significant differences in muscle mass, fat mass, total body fluid, and
visceral fat before and after
hemodialysis, with patients with higher muscle mass tending to have elevated
creatinine levels. This study emphasizes the importance of monitoring body composition and creatinine levels to support
the health of hemodialysis patients and highlights the need for personalized
nutritional and therapeutic interventions in
CKD care. Further research is needed
to explore the long-term impacts of hemodialysis on nutritional status and kidney function. |
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KEYWORDS |
Nutritional Status, Body Composition, Creatinine Levels, Hemodialysis, Chronic Kidney Disease, Ibnu Sina YW-UMI Hospital. |
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This
work is licensed under a Creative Commons Attribution-ShareAlike
4.0 International |
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INTRODUCTION
Hemodialysis
is a form of kidney replacement therapy
that plays a crucial role in filtering the blood
by using a special device to remove excess
fluids, solutes, and toxins
Indonesians
aged ≥15 years are also affected by chronic kidney disease. Chronic kidney
failure is defined as abnormalities in the structure and function of the
kidneys over ≥3 months, characterized by a decrease in the glomerular
filtration rate (LFG). Meanwhile, chronic kidney disease is defined as an
abnormal condition of kidney structure and function that
lasts ≥3 months, with a decrease in GFR of <60 ml/min/1.73 m2
Hemodialysis can not only overcome
or slow down
the decline in acute kidney function
but also provide a solution to maintain kidney
function until the right time for the implementation
of kidney transplantation. Especially for those who
are not eligible for a kidney transplant, hemodialysis remains the top choice as a lifelong kidney replacement therapy
More
than 7 million people in Europe suffer from chronic kidney disease, while
300,000 people undergo kidney replacement therapy through dialysis or kidney
transplantation. In the United States, about 400,000 patients are treated with hemodialysis
Despite its importance, hemodialysis has been associated with notable nutritional and physiological challenges
This study seeks to address this gap by examining the
relationship between nutritional status, body composition, and creatinine
levels in hemodialysis patients at Ibnu Sina YW-UMI
Makassar Hospital. By assessing these variables before and after hemodialysis, this research aims to provide a comprehensive
analysis of how hemodialysis influences the
physiological and nutritional profile of CKD patients. Such findings could help
in developing tailored nutritional and therapeutic strategies to improve
patient outcomes, especially for populations facing high CKD prevalence.
RESEARCH
METHOD
This
study uses an observational research design with a cross
sectional approach. The
source of data in this study is primary data obtained from direct measurements
to determine the sample according to the inclusion and exclusion criteria. This
study was conducted on hemodialysis patients at Ibnu Sina YW-UMI Makassar
Hospital.
No. |
Variable |
Operational definition |
Measuring Instruments |
Measurement results |
Measurement scale |
1 |
Nutritional
Status |
Nutritional
status is a measure of the state of the body indicated by the relationship
between food intake, body composition, and environmental factors. |
|
Interpretation: ·
Underweight:
<18.5 kg/m2 ·
Usual: 18.5 – 22.9 kg/m2 ·
Overweight : 23 – 24.9 kg/m2 ·
Obesity
I: 25 – 29.9 kg/m2 ·
Obesity
II: ³30 kg/m2 |
Categorical
|
2. |
Body
Composition |
· Muscle mass · Fat mass · Total body fluids · Visceral fat |
Bioelectrical Impedance Analysis (BIA) |
·
Muscle
mass - Male : 40-44% - Female : 31-33% From total body weight ·
Fat
mass 16-
29,9% Of total body
weight ·
Total
body fluids 50-60% Of total body
weight ·
Visceral
fat 10% of total fat |
Ratio |
3. |
Creatinine
levels |
Quantitative
measurement of creatinine levels in a blood or urine sample |
Laboratory examination |
Interpretation: 0.6
– 1.2 mg/dL |
Ratio |
The population in this study includes all
patients who were diagnosed with chronic kidney failure for 3 months and
underwent hemodialysis ³for
1 month at Ibnu Sina Hospital YW-UMI Makassar based on inclusion and exclusion
criteria
The sample used is a part of the population
selected by the total sampling method. The inclusion and exclusion criteria
are:
1.
Inclusion criteria
a.
Patients who have been diagnosed with chronic
kidney failure for at least 3 months and have been on hemodialysis for ³1 month
b.
Patients who give written consent to
participate in the study
2.
Exclusion criteria
a.
Patients who are pregnant
b.
Patients with immunocompromised diseases
(HIV/AIDS, Cancer, and chronic infections)
c.
Patients who died in the middle of the study
d.
Patients who are unable to stand for height
and weight measurements
RESULT AND
DISCUSSION
Table 2. Table of Characteristics in Hemodialysis
Patients
Characteristics of Respondents |
N |
Percentage % |
Gender |
||
Male |
10 |
62,5% |
Woman |
6 |
37,5% |
Age |
||
26 - 45 |
4 |
25% |
>45 |
12 |
75% |
Work |
||
Civil servants |
4 |
25% |
Private |
7 |
43,8% |
IRT |
4 |
25% |
None |
1 |
6,3% |
Education |
||
SD |
3 |
18,8% |
SMA |
7 |
43,8% |
S1 |
2 |
12,5% |
S2 |
2 |
12,5% |
None |
2 |
12,5% |
Marital status |
||
Married |
14 |
87,5% |
Unmarried |
2 |
12,5% |
Total |
16 |
100% |
Source: Primary Data Analysis, 2024
Based on gender, the majority of the
research sample is male, with 10 respondents (62.5%), while only 6 respondents (37.5%) are female. According to this
information, it can be concluded that there are more hemodialysis patients at
Ibnu Sina YW-UMI Makassar Hospital who are male or male respondents in this study than female respondents.
Based on age, 12 respondents
(75%) were over 45 years old,
while 4 respondents (25%)
were between 26 and 45 years old. This
shows that 75% of the hemodialysis
patients at Ibnu Sina YW-UMI Makassar Hospital who
are the research samples are in the elderly category (elderly), while the rest
(25%) are in the adult category.
Based
on their occupations, most of the sample in this study worked as private
workers. Where there were 7
respondents, or 43.8% of the total sample,
who worked as private workers. Furthermore, the research sample worked as civil servants and IRTs,
with as many as 4 respondents (25%). Meanwhile, for the research
sample that did not have a job, there was
1 respondent, or 6.3% of the total research
sample.
Based
on the level of education, most of the research sample had the last level of
education in high school (SMA), which was as many as 7 respondents or 43.8% of
the total research sample. Then, the research sample that completed their
education only up to elementary school (SD) had 3 respondents (18.8%). Then, the research
sample that had S1 education was 2 respondents (12.5%), and S2 was 2 respondents (12.5%). In
addition, this study sample has 2 respondents (12.5%) who did not receive
education.
Based on their marital status, the majority of
the sample in this study was married, namely 14 respondents, or 87.5% of the total research
sample. Meanwhile, the unmarried research
sample was 2 respondents (12.5%). With that, it can be concluded that most of
the hemodialysis patients at Ibnu Sina YW-UMI Makassar Hospital are married or have
a family.
Table
3. Characteristic Table of Nutritional Status Before and After Hemodialysis
Nutritional Status |
Before Hemodialysis |
After Hemodialysis |
Change (kg/m2) |
||
n |
Mean |
n |
Mean |
||
Less |
2 |
17.35 |
3 |
16.86 |
-0.48 |
Usual |
9 |
21.04 |
8 |
20.45 |
-0.59 |
More |
5 |
26.3 |
5 |
25.73 |
-0.56 |
Total |
16 |
21.56 |
16 |
21.01 |
-0.54 |
Source: Primary Data Analysis, 2024
Based
on Table 3. 0 information was obtained that before the hemodialysis process was
carried out, there were 2 respondents categorized as malnourished with an
average of 17.35 kg/m2, 9 respondents were categorized as having a normal
nutritional status of 21 kg/m2, 5 respondents were categorized as being
overnourished at 26.3 kg/m2. Then, after the hemodialysis
process was carried out, there
were 3 respondents categorized
as having a malnourished
status of 16.86 kg/m2, 8 respondents
categorized as having a normal
nutritional status of 20.45
kg/m2, 5 respondents categorized
as having an overnourished status of 25.73
kg/m2. Furthermore, it is known that there are changes in BMI before and
after hemodialysis. In the Under-BMI,
there was a decrease of
0.48 kg/m2, the Normal BMI decreased by -0.25 kg/m2, and the Over-BMI decreased
by -0.56 kg/m2.
According to this description,
it can be
concluded that 1 respondent experienced a decrease in nutritional status. Before the hemodialysis
process, the respondent had a normal nutritional
status, which decreased to malnourished status after the hemodialysis
process.
Table
4. Body Composition Table Before and After Hemodialysis
Body Composition |
Before Hemodialysis |
After Hemodialysis |
Change (%) |
||
n |
Mean |
n |
Mean |
||
Muscle Mass |
|
|
|
|
|
Less |
3 |
35,01 |
1 |
43,23 |
8,21 |
Usual |
5 |
38,97 |
3 |
42,23 |
3,26 |
More |
8 |
42,89 |
11 |
44,96 |
2,07 |
Total |
16 |
40,18 |
16 |
44,34 |
4,5 |
Fat Mass |
|
|
|
||
Less |
0 |
0 |
3 |
19,1 |
19,1 |
Usual |
7 |
32,43 |
10 |
23,1 |
-9,42 |
More |
9 |
33,36 |
3 |
25,2 |
-8,16 |
Total |
16 |
32,95 |
16 |
22,68 |
-10,27 |
Total Fluid |
|
|
|
|
|
Less |
1 |
45,90 |
7 |
49,24 |
-3,34 |
Usual |
9 |
58,15 |
9 |
50,22 |
-7,93 |
More |
6 |
59,46 |
0 |
0 |
-59,46 |
Total |
16 |
57,8 |
16 |
49,79 |
-8,08 |
Visceral Fat |
|
|
|
|
|
Less |
7 |
8,67 |
13 |
6,74 |
-1,9 |
Usual |
5 |
10,18 |
2 |
10,45 |
-0,59 |
More |
4 |
13,2 |
1 |
15 |
2,8 |
Total |
16 |
10,27 |
16 |
7,72 |
-2,55 |
Source: Primary Data Analysis, 2024
Based on Table 4, the
body composition in this study is proxied
with four indicators: muscle mass, fat mass,
total fluid, and visceral fat. All of these indicators are measured
before and after the hemodialysis process. Then, each indicator is classified into
three categories: Less, Normal, and Over.
For
the muscle mass indicator before hemodialysis was carried out, it was known
that there were 3 respondents in the Less category with an average muscle mass
of 35.01%, 5 respondents in the Normal category of 38.97%, and 8 respondents in
the More category of 42.89%. Furthermore, after hemodialysis, it was found that
there were 1 respondent in the Less category of 42.23%, 3 respondents in the
Normal category of 42.23%, and 11 respondents in the Over 44.96% category.
According to this description, it was concluded that both before and after the
hemodialysis process, most of the research samples were in the condition of
muscle mass in the category of "Over".
Next,
for the fat mass indicator
in the period before hemodialysis was carried out,
it was known
that there were 7 respondents in the Normal category of 34.43% and 9 respondents in the Over category of 33.36%. After hemodialysis, it was found
that 3 people were in the less than
19.1% category, 10 respondents
in the Normal category were
23.1%, and 3 respondents
were in the more than 25.2% category. According to this
description, it was concluded that
before hemodialysis, the dominant had more fat mass,
but after the hemodialysis process, the dominant
sample was in the condition
of fat mass in the "Normal" category. In addition, if the data in the
table is observed, it is known that there is a change in fat mass before and
after hemodialysis. Respondents in the normal category experienced an average decrease in fat mass of
-9.42%; the more category experienced a decrease of -8.16%.
Then,
for the total fluid indicator in the period before hemodialysis was carried
out, it was known that there were 1 respondent in the Less category having an
average total fluid of 45.90%, 9 respondents in the Normal category of 58.15%,
and 6 respondents in the Over category of 59.46%. Furthermore, after
hemodialysis, it was found that there were 7 respondents in the Less category
of 49.24%, 9 respondents in the Normal category of 50.22%, and none of them had
more body fluids. According to this description, it was concluded that after
the hemodialysis process, most of the research samples were in the condition of
total fluid in the "Normal" category, where there were as many as 9
respondents. In addition, if the data in the table is observed, it is known
that there is a decrease in total fluid after hemodialysis. Respondents
in the less category experienced an average decrease
in total fluids of -3.34%, the normal category of -7.93%, and the more category
of -59.46%.
Furthermore,
for the visceral fat indicator in the period before hemodialysis, it is known
that there are 7 respondents in the Less category with an average of 8.67%
abdominal fat, 5 respondents in the Normal category of 10.18%, and 4
respondents in the More category of 12.12%. Furthermore, after hemodialysis, it
was found that there were 13 respondents in the Less than 6.74% category, 2
respondents in the Normal category (10.45%), and 1 respondent in the Over 15%
category. According to this description, it was concluded that both before and
after the hemodialysis process, most of the research samples were in the
condition of visceral fat in the category of "lacking". In addition, if the
data in the table is observed, it is known that
there is a decrease in visceral fat after hemodialysis. Respondents
in the less than category experienced
a decrease of -1.9, and the normal category decreased by -0.59.
Table
5. Table Based on Creatinine Levels
Before and After Hemodialysis
Creatine Levels |
Before Hemodialysis |
After Hemodialysis |
Change (mg/dL) |
||
n |
Mean |
n |
Mean |
||
Usual |
1 |
1,2 |
4 |
1,05 |
-0,15 |
Abnormal |
15 |
6,76 |
12 |
3,40 |
-3,35 |
Total |
16 |
6,41 |
16 |
2,81 |
-3,59 |
Source:
Primary Data Analysis, 2024
Based
on Table 5. It is known that before the hemodialysis process was carried out,
there was 1 respondent who had a normal creatinine level with an average of 1.2
mg/dL, and 15 respondents had an abnormal creatinine level of 6.76 mg/dL. Then, after the
hemodialysis process was carried out,
there were 4 respondents with normal creatinine levels of 1.05 mg/dL and
12 respondents with
abnormal creatinine levels
(3.40 mg/dL). In accordance
with that, it can be concluded that both before and after the hemodialysis
process, most of the research samples had abnormal creatinine levels. However, based on the data in the table, it
is known that creatinine levels after the
hemodialysis process decreased, namely in the normal category by -0.15 mg/dL
and in the abnormal category by -3.35 mg/dL.
The
purpose of the bivariate analysis
was to analyze
the effect of hemodialysis on nutritional status, body composition (muscle
mass, fat mass, total body fluid, and visceral fat), and creatinine levels
before and after the hemodialysis process in hemodialysis patients at Ibnu Sina
YW-UMI Makassar Hospital. The relationship test will be
carried out and analyzed using
the paired T-Test where the
data obtained will be processed using
computerized Statistical
Social Science (SPSS).
Then, the level of confidence or significance in this study is 0.05. So, if the
Asymp value. Sig. (2-tailed) < 0.05 (H0 rejected), which means that there is
a relationship between the independent and dependent variables. On the other
hand, if Asymp. Sig. (2-tailed) > 0.05 (H1 is accepted) means no meaningful relationship
exists between the independent and dependent variables. The results of the test are shown in the table below.
Table
6. Analysis of Nutritional Status Before and After Hemodialysis
N |
Average |
p |
||
Before HD |
After HD |
|||
Nutritional
Status (BMI) |
16 |
21,56 |
21,01 |
0,000 |
Source: Primary data analysis paired
t-test
Based on Table 6, it
is known that the value
of p 0.00 means the value of
p <0.05. Therefore, it can be concluded that the results of the
T-test show a significant difference between nutritional status before and
after hemodialysis. This shows
that the hemodialysis carried out significantly impacts the decrease
in nutritional status.
Table 7. Body Composition
Analysis Before and After Hemodialysis
Variable |
N |
Average |
p |
|
Before HD |
After HD |
|||
Muscle Mass |
16 |
40,18 |
44,34 |
0,043 |
Fat Mass |
16 |
32,95 |
22,68 |
0,000 |
Total Body Fluids |
16 |
57,88 |
49,79 |
0,000 |
Visceral Fat |
16 |
10,27 |
7,72 |
0,001 |
Source: Primary data analysis, 2024 paired
T-test
Based on the table
above, the p-value of muscle
mass, which is 0.043 or <0.05, then the p-value of fat
mass, total body fluid is obtained
as 0.00 or <0.05, while the p-value of visceral fat
is 0.001 or <0.05, so it is
concluded that the results of
the T-test show a significant difference after hemodialysis.
Table 7. Creatinine Level Analysis
Before and After Hemodialysis
Variable |
N |
Average |
p |
|
Before HD |
After HD |
|||
Creatine Levels |
16 |
6,41 |
2,81 |
0,000 |
Source: Primary data analysis Paired
T-Test
Based on the table
above, the p-value of creatinine
levels is 0.00 or <0.05, so it can be
concluded that the results of
the T-test show a significant difference in creatinine levels after hemodialysis.
Discussion
Kidney
failure is a condition in which the kidneys are unable to remove the body's
metabolic waste or carry out its normal functions. Substances that are normally
excreted through the urine accumulate in body fluids due to impaired renal
excretion, causing impaired endocrine and metabolic function, as well as fluid
balance, electrolytes, and alkaline acids. Chronic kidney failure or end-stage
kidney disease is a progressive and continuous damage to the structure of the
kidneys. In Indonesia, the most
common renal function replacement therapy is hemodialysis.
The
indicator used to determine kidney function is called creatinine levels.
Creatine is a residual product of muscle metabolism that is released into the
blood and then filtered by the kidneys and excreted through the urine.
Creatinine levels that are too high indicate kidney function that is not
working properly (kidney failure). A number of factors can affect the high or
low production of creatinine. In this study, the analysis focused on the
discussion of the relationship between nutritional status and body composition
to creatinine levels of Hemodialysis Patients at Ibnu Sina Hospital YW-UMI
Makassar.
Furthermore,
the discussion of the results of this study is based on data analysis and
findings of the dissemination of primary data obtained from the results of
nutritional status measurement based on Body Mass Index (BMI) and body
composition measurements consisting of muscle mass, fat mass, total fluid, and
abdominal fat, and followed by examination of creatinine levels before and
after hemodialysis to contribute to the relationship between nutritional status
and body composition to creatinine levels in Hemodialysis Patients of Ibnu Sina
Hospital YW-UMI Makassar.
Based
on the results of primary data processing, it is known that most of the
hemodialysis patients at Ibnu Sina YW-UMI Makassar Hospital are male. This
shows that hemodialysis patients are more male than female. These findings are
in line with studies, which revealed that the amount of creatinine excreted
each day is more influenced by a person's muscle mass than by muscle activity
or protein metabolism rate. Therefore, creatinine values in men tend to
be higher because men generally
have greater muscle mass than
women
In
addition, it is known based on primary data that most of the Hemodialysis
Patients at Ibnu Sina YW-UMI Makassar Hospital are patients
with the age of >45 or
are in the category of "middle age" to "elderly" Elderly.
This is in line with studies, where it is revealed that kidney failure tends to
increase with age due to decreased
kidney function (high creatinine levels), and the
elderly are more often associated with an increased
prevalence of chronic diseases such as diabetes and hypertension
Next,
based on the results of data processing, it is known that there is a
relationship between nutritional status and creatinine levels. In addition, it
is also known that most of the Hemodialysis Patients at Ibnu Sina YW-UMI
Makassar Hospital have "Normal" nutritional status and abnormal creatinine levels. A number of studies that
produced similar findings include research from Beberashvili
et al.
Next,
based on the results of data processing, information was obtained that there
was a relationship between body composition and creatinine levels. The body
composition intended in this study consists of muscle mass, fat mass, total
fluid, and abdominal fat. Then, according
to the results
of the Chi-Square Test, it
was known that most Hemodialysis
Patients at Ibnu Sina
YW-UMI Makassar Hospital with muscle
mass in the
"Over" category had abnormal creatinine levels. This shows
that patients with large or more than average muscle mass will have high and
even abnormal creatinine levels. Bioelectrical impedance analysis can measure muscle
mass, but hemodialysis patients often have excess
body fluids, which can affect
muscle mass measurement and ultimately reduce the accuracy of
muscle mass monitoring. The findings of this study are in line with those
of other studies. About 98% of the body's
total creatinine accumulates
in the muscles, and some of
the free creatine in the muscles spontaneously and fairly constantly
converts into its anhydride waste
products. Creatinine in muscle mass often
makes it difficult to evaluate
kidney function in individuals with below-average muscle mass, such as children,
adults, and older adults or
those with muscle wasting disease
Furthermore,
according to the results of data processing, it is known that most of the
majority of Hemodialysis Patients at Ibnu Sina YW-UMI Makassar Hospital with
normal fat mass have normal and abnormal creatinine levels. Meanwhile, the
second majority position is patients with more category fat mass who have
abnormal creatinine levels. Based on
the data processing results, It is
also known that most of
the Hemodialysis Patients at Ibnu Sina YW-UMI Makassar Hospital whose
visceral fat is categorized as normal have abnormal creatinine levels. This
suggests that individuals with normal visceral fat have high or abnormal
creatinine levels. A study conducted by Kim et al. (2014) showed that fat mass
is a significant risk factor for patients with chronic kidney failure. In
addition to this, Chen et al. (2018) also found that body fat has a detrimental
effect on kidney function. Cross-linking between fat mass
and blood vessels, fat mass
causes vascular dysfunction through large vasoconstriction secretions, through the renin-angiotensin-aldosterone system, superoxide, and pro-inflammatory adipokines that are contributors to endothelial activation and inflammation of blood vessels. It is said that
the accumulation of fat mass is closely related to the incidence of chronic
kidney failure.
Next,
it was known that most of the Hemodialysis Patients at Ibnu Sina Hospital
YW-UMI Makassar with a total fluid of the normal category had normal and
abnormal creatinine levels, where the respondents had abnormal creatinine more
(80%) than those with normal creatinine (20%). These results suggest that total fluid is directly related
to the patient's
creatinine levels. This
finding is supported by the study of Herlina S (2021) and Isron L (2014), where
it is known that one of the factors for increasing creatinine levels is total
body fluids, namely excess body fluids, which can result in edema, heavy
circulation load, and water intoxication which causes a decrease in kidney
function that cannot maintain homeostasis. So in line with the
results of the study, there was a decrease in total fluid followed by
a decrease in creatinine levels before and after hemodialysis. However, the decrease
in body fluids must still be
monitored because it can cause
dehydration and hypotension related to kidney function.
CONCLUSION
This study concludes that hemodialysis significantly impacts the nutritional
status, body composition, and creatinine levels in chronic kidney failure patients at Ibnu Sina YW-UMI
Makassar Hospital. Findings reveal
that hemodialysis patients predominantly have abnormal creatinine levels despite maintaining a normal nutritional
status, with changes noted in body composition
indicators such as muscle mass, fat
mass, and total body fluid. Notably,
the study underscores the relationship between muscle mass and elevated
creatinine levels, while excess body
fluids further correlate with impaired kidney function. These insights affirm that regular monitoring
and tailored nutritional and fluid management in hemodialysis patients are crucial to optimizing
kidney function and patient health
outcomes.
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