Assessment of Nutritional Status and Related Factors Among Patients Undergoing Maintenance Hemodialysis at Hargeisa Group Hospital, Somaliland

Assessment of Nutritional Status and Related Factors Among Patients Undergoing Maintenance Hemodialysis at Hargeisa Group Hospital, Somaliland | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Nutritional Status and Related Factors Among Patients Undergoing Maintenance Hemodialysis at Hargeisa Group Hospital, Somaliland abdulkadir Mohamed Nuh, Abdeta Mukhtar Ahmed, Hamse Arab Ali, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5735056/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Chronic kidney disease (CKD) is a long-term condition characterized by the gradual loss of kidney function over time with a reduction in the glomerular filtration rate. More than 800 million people are affected by chronic kidney diseases worldwide. Its prevalence is notably pronounced among older populations and those with inadequately managed diabetes mellitus and hypertension. Nutritional status among patients with chronic kidney disease (CKD) in East African countries, including Somaliland, has emerged as a significant concern requiring comprehensive attention. Several studies conducted across this region have indicated varying degrees of malnutrition among CKD patients. Objective: This study aimed to assess nutritional status and related factors among patients with chronic kidney disease on haemodialysis at Hargeisa Group Hospital, Hargeisa, to generate evidence for practice. Methods: An institution-based cross-sectional study was conducted for a period of four weeks from 30 June to 27 July 20222 at Hargeisa Group Hospital, Department of Haemodialysis. Results : A multivariate linear regression model adjusted for different background characteristics, duration of chronic kidney disease, scheduled physical activity before becoming sick, history of anorexia and hemoglobin level was significantly associated with nutritional status (P < 0.05). For a unit increase in the duration of chronic kidney disease, the SGA-DMS score increased by 0.061 (ß = 0.061, P < 0.001). Similarly, a unit increase in the duration of anorexia (SGA-DMS) score increased by 4.746 (ß = 4.746, P < 0.001), indicating malnutrition. Conversely, having any scheduled physical activity before becoming sick decreased the SGA-DMS score by -4.604 (ß = -4.604, P =0.042). Conversely, a unit increase in the haemoglobin level decreased (SGA-DMS) the score by -1.463 (ß = -1.463, P =0.014). Conclusion : Malnutrition is notably prevalent among hemodialysis patients at Hargeisa Group Hospital, particularly among those subjected to extended dialysis and those with a history of anorexia. Nutrition & Dietetics CKD nutritional status haemodialysis clinical profile Figures Figure 1 Introduction Background Chronic kidney disease (CKD) presents a burgeoning global health challenge, with increasing prevalence rates internationally. This condition is intrinsically linked to severe repercussions, including kidney failure, cardiac issues, and premature mortality ( 1 , 2 ), characterized by irreversible renal impairment or a diminished glomerular filtration rate ( 3 ). CKD afflicts more than 800 million individuals globally. Its prevalence is notably pronounced among older populations and those with inadequately managed diabetes mellitus and hypertension ( 4 ). As a predominant noncommunicable ailment contributing to global mortality, the incidence of CKD continues to increase, underscoring its increasing importance in the global mortality landscape( 5 ). Differences in CKD prevalence across regions suggest variances in population demographics, prevalent noncommunicable diseases, associated comorbidities, and healthcare accessibility ( 6 ). The nutritional status of chronic kidney disease (CKD) patients varies significantly across different regions, reflecting a complex interplay of socioeconomic, cultural, healthcare, and environmental factors( 7 ). Globally, CKD patients often face nutritional challenges, including protein-energy wasting, malnutrition, and metabolic disturbances, which contribute to increased morbidity and mortality rates ( 8 ). In Africa, including sub-Saharan Africa, the nutritional status of CKD patients is particularly concerning due to limited access to healthcare resources, inadequate infrastructure, socioeconomic disparities, and prevalent comorbidities such as infectious diseases, malaria, and HIV/AIDS. These factors exacerbate the nutritional vulnerability of CKD patients, leading to increased rates of malnutrition, micronutrient deficiencies, and associated complications ( 9 , 10 ). Nutritional status among patients with chronic kidney disease (CKD) in East African countries, including Somalia, has emerged as a significant concern requiring comprehensive attention( 11 ). Several studies conducted across this region have indicated varying degrees of malnutrition prevalence among CKD patients, underscoring the multifaceted challenges faced by this population( 12 ). Studies focusing on nutritional status among chronic kidney disease (CKD) patients in Somalia, particularly Somaliland, may not have been widely documented in accessible global databases. However, it is crucial to recognize that nutritional challenges and healthcare infrastructure in these regions might have significant implications for CKD patients' nutritional status ( 12 ). Although hemodialysis services are being provided to CKD patients at Hargeisa Group Hospital, their association with nutritional status has not been determined. This study investigated nutritional status and its associated factors among CKD patients on haemodialysis in Hargeisa, Somaliland, to generate evidence for improving patient care. Methods Study design, period, and setting An institution-based cross-sectional study was conducted for four weeks from 30 June to 27 July, 20222, at Hargeisa Group Hospital, Department of Haemodialysis. The hospital was built in 1951 by the British Administration and currently has 400 beds with daily average visitors of more than two hundred and sixty patients with a catchment population of more than one million. It provides health care services for other regions and districts of Somaliland. There are over seven hundred clinical and nonclinical staff members in six main departments. The most recently launched new haemodialysis unit treats varying numbers of patients ( 12 ). Sample size : The sample size was calculated via the RAOSOFT sample size calculator ( 13 ) on the basis of the following assumptions: 5% margin of error, 95% confidence level, and response distribution of 50%. The total number of people registered for haemodialysis at the time of data collection was 77. Sampling technique A consecutive sampling method was employed to select each study unit because the total number of cases included in the hemodialysis was small. Data collection and measurements: Data were collected face-to-face via structured interviewer-administered questionnaires and anthropometric measurements. A structured questionnaire was used to collect sociodemographic data, family history of chronic disease, presence of comorbidities, and risky lifestyle behavior, and dietary practice was assessed via a semiquantitative dietary history method. To evaluate the nutritional status of patients with chronic kidney disease (CKD), a quantitative subjective global assessment-dialysis malnutrition score (SGA-DMS) was employed. This assessment tool was adapted from the established SGA framework delineated by Kalantar et al. ( 14 ). The SGA-DMS encompasses seven distinct components, namely, weight change, dietary intake, gastrointestinal symptoms, functional capability, comorbidities, subcutaneous fat levels, and indications of muscle wasting. Each of these components is assigned a score ranging from 1 (indicating normal) to 5 (indicating severe malnutrition). Consequently, the cumulative malnutrition score, derived from the aggregation of scores across all seven components, ranges between 7, indicative of a normal nutritional status, and 35, reflecting severe malnourishment. A lower score denotes a tendency toward a normal nutritional status. A higher score is an indicator of the presence of malnutrition. For more operationalizing the assessment score Malnutrition score = sum of all 7 items Minimum score 7 Maximum 35 Assessing nutritional status Well nourished at 7 Mildly malnourished > 7 < 21 Moderately Malnourished 21–34 Severe Malnutrition 35 Anthropometric measurements were also taken. The anthropometric measures of weight and height were measured via standard techniques ( 15 ). Body weight was measured on a digital anthropometric weighing scale. The scale was placed on a squamous flat floor surface. The weighing scales were validated with a known weight object every time and checked against zero readings after every participant was weighed. All patients' weights were measured and taken to the nearest 0.1 kg. Height was measured via a portable stadiometer to the nearest 0.1 cm. Height was measured in all participants, with the weight distributed between the feet, and heels together, in an upright posture, with the head free of props and looking straight ahead at a fixed point at eye level. Body mass index was calculated as weight in kg and height in meters squared on the basis of weight and height. Consequently, the most recent data on laboratory markers, such as serum albumin, serum creatinine, blood urea nitrogen (BUN), haemoglobin (Hb), and blood pressure , were taken from the files of each patient. Statistical analysis The collected data were manually checked for completeness and consistency. The data were subsequently entered into SPSS software version 23 for cleaning and analysis. The data were checked for missing values and outliers before analysis. Descriptive statistics were used to examine the frequency distributions of the study variables. A multivariable linear regression model was run to isolate independent predictors of nutritional status among patients with chronic kidney disease. Assumptions for linearity, normality, homoscedasticity and the likelihood of multicollinearity were checked for the model. A P value < 0.05 was considered to indicate statistical significance. Model fitness was assessed via adjusted R 2 . Results Socioeconomic and demographic characteristics of CKD patients Among the 65 participants in the study, 67.3% were males and 32.3% were females. The mean (± SD) age was 51.88 ± 8.91 years, with a range of 30–65 years. Only 4.6% were in stage four, whereas 95.6% were in stage five. Nearly 91% of the respondents were married, whereas only 9% were single. With respect to educational level, 38.5% did not attend formal education, whereas 61.5% had different formal education levels, such as primary, secondary, and tertiary levels. A total of 78% of the study participants were unemployed, whereas only 21.5% were employed (Table 1 ). Table 1 Socioeconomic and demographic characteristics of CKD patients attending Hargeisa Group Hospital, Hargeisa, Somaliland, from June 5 to 30 July, 2022 (n = 65). Characteristics of study Participants Frequency Percent Sex Female 21 32.3 Male 44 67.7 Age category ≤ 40 years 11 17 > 40 years 54 83 Marital status Single 6 9.2 Married 59 90.8 Occupation Employed 51 78.46 Unemployed 14 21.5 Family size ≤7 26 40 >7 39 60 Educational level Formal Education 25 38.46 None formal education 40 61.53 Disease-related characteristics of CKD patients Disease-related characteristics of the respondents Nearly 70% of the respondents reported that they had a family history of chronic diseases, 38.4% had a family history of hypertension only, 4.6% had chronic kidney disease (CKD), and 26% had diabetes mellitus (DM) together with hypertension. Seventy-two percent of the study participants reported that they had other chronic diseases before they suffered from chronic kidney disease (CKD), with 38.3% having hypertension, 32.3% having hypertension with diabetes mellitus and only 4.6% having diabetes mellitus only. With respect to current status, all the respondents reported that they had comorbid conditions. Among those with hypertension (55.3%), 6.2% were diabetic, while 38.5% had both DM and hypertension. In terms of the duration of CKD among patients, 60% of patients had CKD for 2 years or more, whereas 40% had CKD for less than 2 years (Table 2 ). Table 2 Disease-related characteristics of CKD patients attending Hargeisa Group Hospital, Hargeisa, Somaliland, from June 27 to 30 July, 2022 (n = 65) Characteristics of study Participants Frequency Percent Family history of chronic diseases Female Male Yes 15 30 69.2 No 6 14 30.7 Type of chronic disease Hypertension only 8 17 38.4 CKD 0 3 4.6 DM and hypertension 7 10 26 Any chronic disease before current CKD Yes 15 32 72.3 No 6 12 27.7 Type of chronic disease before current CKD Hypertension only 6 17 35.3 DM and Hypertension 9 12 32.3 DM only 0 3 4.6 Status of chronic other chronic diseases in the patients Hypertension 11 25 55.3 DM 1 3 6.2 Both DM and Hypertension 9 16 38.5 Duration of CKD 2 years and above 11 28 60 Less than 2 years 10 16 40 Risky lifestyle-related characteristics of CKD patients Most of the male respondents had a history of tobacco smoking, while there was no history of tobacco smoking among females, but currently, no one smokes tobacco. Ninety-two percent of the respondents had less than twenty minutes of scheduled physical activity before, whereas only 8% had more than twenty minutes. Only 9.2% of patients had exercise plans set with their doctors, whereas the other patients did not. In the current activity, 90% of the study participants were sedentary. In terms of dietary-related characteristics, 32.3% were still dependent on eating foods from restaurants, whereas 67.7% ate special foods prepared in their homes. Although most patients had a low level of salt, only 3.8% consumed the right quantity of salt. Eighty-six percent of the respondents consumed different fruits and vegetables most of the time. A total of 56.9% had experienced anorexia, 39.4% had a loss of appetite most of the time, and 43.1% had no anorexia (Table 3 ). Table 3 Risk lifestyle-related characteristics of CKD patients at Hargeisa Group Hospital, Hargeisa, Somaliland, June 30 to 27 July 2022 (n = 65) Characteristics of study Participants Frequency Percent History of tobacco smoking Yes No 38 27 58.6 41.5 Scheduled Physical activities before sick < 20 minutes ≥ 20 60 5 92 8 Exercise plan set with your doctor Yes No 6 59 9.2 90.8 Current activity Sedentary Low activity (< 3 km) 59 6 90.7 9.3 Eating foods regularly from restaurant Yes No 21 44 32.3 67.7 Eating meat and meat product Never Once or twice week 40 25 61.5 38.5 Salt consumption Right amount Too small amount 9 56 13.8 86.2 Doctor’s advice to reduce salt consumption Yes No 58 7 89.2 10.8 Consumption of fruits and vegetables Yes No 56 9 86.2 13.8 Frequency of fruit and vegetable conception Most often Rarely 47 11 72.3 16.9 Dietary plan set with doctor Yes No 61 4 93.8 6.2 History of anorexia Yes No 37 28 56.9 43.1 How often do you experience loss to appetite Most of the time Rarely 23 14 35.4 21.5 Anthropometric and biochemical markers: An increase in the creatinine level indicates impaired kidney function. In the present study, the serum creatinine level of all patients was very high. The mean and standard deviation of the creatinine level were 8.5 ± 2.42. The level of haemoglobin, which indicates the level of anaemia, was very low, which means that many study participants were anaemic. Among the 65 participants, only 18.5% were underweight, and only 4.6% were overweight, while the rest were normal after calculation of their body mass index (Table 3 ). The mean and standard deviation of diastolic and systolic blood pressure were 156.6 ± 21.6 and 112 ± 78.2, respectively (Table 4 ). Table 4 Anthropometric and biochemical marker characteristics of CKD patients at Hargeisa Group Hospital, Hargeisa, Somaliland, from June 30 to 27 July 2022 (n = 65) Variable Frequency Percent Creatinine level g/dl > 1.4 =10 13 20 Haemoglobin value (g/dl) For Females ≤ 12 > 12 17 81 4 19 For males ≤ 13 > 13 38 86.4 6 13.6 Body mass index (BMI) 30 3 4.6 Stages of CKD Stage four 3 4.6 Stage five 62 95.4 Characteristics Value (mean ± SD) Systolic blood pressure 156.6 ± 21.6 Diastolic blood pressure 112 ± 78.2 Blood urea nitrogen 131 ± 47.2 Nutritional status of hemodialysis patients by using a modified subjective global assessment of dialysis malnutrition score As shown in the figure above (Fig. 1 . Over 90% of patients undergoing hemodialysis display indications of malnutrition, predominantly mild to moderate malnutrition. This prevalence of malnutrition among patients undergoing hemodialysis is a matter of significant concern within the healthcare community because malnutrition in this population can exacerbate existing health conditions, compromise immune function, and diminish overall quality of life. Understanding the extent of malnutrition, as highlighted by the figure, underscores the urgency for healthcare providers to prioritize nutritional assessments and interventions for these patients. Early identification and management of malnutrition can potentially improve treatment outcomes, reduce hospitalizations, and increase the overall well-being of individuals undergoing hemodialysis. Multivariable linear regression model for predicting malnutrition among patients on hemodialysis at Hargeisa Group Hospital A multivariable linear regression model adjusted for different background characteristics, duration of chronic kidney disease, scheduled physical activity before becoming sick, history of anorexia and hemoglobin level were significantly associated with nutritional status (P < 0.05). Having scheduled physical activities before becoming sick and a history of anorexia and duration of CKD were negatively associated with the nutritional status of patients undergoing hemodialysis (P < 0.05), whereas the hemoglobin level was positively associated with the nutritional status of CKD patients receiving hemodialysis. As shown in Table 5 , for a unit increase in the duration of chronic kidney disease, nutritional status decreased by -0.061 (ß = -0.61, P < 0.001). Similarly, with a unit increase in the duration of anorexia, nutritional status decreased by -4.746 (ß = -4.746, P < 0.001); similarly, having any scheduled physical activities before becoming sick decreased the nutritional status of patients on hemodialysis by -4.604 (ß = -4.604, P = 0.042). Conversely, an increased haemoglobin level was associated with an increase in nutritional status of 1.463 (ß = 1.463, P = 0.014). Table 5 Multivariate linear regression model for predicting malnutrition among patients on hemodialysis at Hargeisa Group Hospital, Hargeisa, Somaliland Model Unstandardized Coefficients P 95.0% CI B Std. Error Lower Bound Upper Bound Duration of chronic kidney diseases -0.061 0.013 < 0.001 0.034 0.087 glomerular filtration rate -0.108 0.199 0.590 -0.508 0.291 Current Activity level 2.067 1.987 0.303 -1.914 6.048 family history of chronic diseases -0.243 1.364 0.859 -2.976 2.490 Having scheduled physical activities before you becoming sick -4.604 2.212 0.042 -9.035 -0.173 history of anorexia -4.746 1.221 < 0.001 -7.192 -2.300 do you eat fruit and vegetables 2.162 1.588 0.179 -1.019 5.343 Hemoglobin level 1.463 .579 0.014 .303 2.623 Maximum VIF: 1.692, CI: Confidence interval. Discussion Malnutrition frequently occurs in patients undergoing haemodialysis therapy, often leading to elevated rates of morbidity and mortality ( 16 ). On the basis of the modified SGA scoring method, the findings of this study revealed that 92% of the patients presented signs of malnutrition (80% categorized as mild cases and 12% classified as moderate malnutrition). This result was higher than those of similar studies performed in Egypt and Tanzania, which reported values of 85.2% and 61.2%, respectively ( 17 , 18 ). The results of this study were in line with those of another similar study performed in Porur, Chennai, India, in which 91% of patients were mild to moderately malnourished. The quantitative measures of malnutrition showed significant differences between sexes, with males demonstrating a greater prevalence of malnutrition than females did. The duration of chronic kidney disease (CKD) can have a significant effect on an individual's nutritional status ( 19 ). As CKD progresses over time, it often leads to various metabolic and physiological changes in the body that can affect dietary intake, nutrient metabolism, and overall nutritional well-being ( 20 ). Further multivariable linear regression analyses revealed that an increased duration of CKD decreased nutritional status because, in the early stages of CKD, individuals may experience subtle changes in appetite, taste alterations, and metabolic disturbances, which can contribute to inadequate nutrient intake ( 21 ). As CKD progresses, there may be increased proteinuria, loss of essential nutrients in the urine, and alterations in the body's ability to regulate electrolytes and acid‒base balance, further complicating nutritional status ( 22 ). A prolonged duration of CKD is associated with a greater risk of malnutrition due to factors such as decreased protein synthesis, increased protein catabolism, and metabolic acidosis ( 23 ). In this study, a significant association was observed between a history of anorexia in patients with chronic kidney disease (CKD) and the prevalence of malnutrition. Patients with a prior history of anorexia were at heightened risk of experiencing malnutrition. The occurrence of anorexia among CKD patients can lead to malnutrition due to insufficient dietary intake, resulting in deficiencies in essential nutrients such as protein and calories ( 21 ). This nutritional deficiency over time can worsen the complications related to CKD, compromise the immune response, hinder wound healing processes, and increase the risk of morbidity and mortality ( 24 ). On the other hand, this study revealed a positive relationship between elevated haemoglobin levels and the nutritional status of patients with chronic kidney disease (CKD). An increased level of hemoglobin in chronic kidney disease (CKD) patients often signifies improved oxygen-carrying capacity and may have implications for their nutritional status ( 25 ). Hemoglobin is a vital protein in red blood cells that is responsible for transporting oxygen throughout the body. In CKD patients, an elevated haemoglobin level may indicate effective management of anaemia, a common complication in CKD patients due to reduced erythropoietin production ( 26 , 27 ). Conclusion Malnutrition is notably prevalent among haemodialysis patients at Hargeisa Group Hospital, particularly among those subjected to extended periods of haemodialysis and those with a history of anorexia. Predominantly, patients exhibited mild to moderate malnutrition. On the basis of these findings, we suggest routine screening of hemodialysis patients to identify malnutrition promptly. Timely and appropriate intervention is imperative, as unaddressed malnutrition may precipitate unfavourable clinical outcomes. Declarations Ethical approval and consent to participants The ethical committee from the research and quality assurance office of the Addis ababa medical university college Hargeisa Campus approved the all procedure used this study. 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Chronic Kidney Disease: Diagnosis Treat. :123–139 Gityamwi N Nutrition, body composition, inflammation and haemoglobin status among haemodialysis patients on Erythropoietin maintenance therapy (Doctoral dissertation, University of Surrey) Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5735056","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":395963602,"identity":"efaf108a-1fb4-43de-b325-b816a39d4197","order_by":0,"name":"abdulkadir Mohamed Nuh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYDACCQYDhgcHGBjbgGxmhgobOZDggQeEtCTAtZxJMwZrSSBGSwNIC2Pb4UQQgwGfFv7ZzdskEs7YyfZJnz0mXdjGnD4/7PBDoC12croNOCy5c6xMIuFGsnEbX16a9IxzbLkbb6cZALUkG5sdwGHNjRwziYQPzIltPDxm0jxlPLkbZyeAtBxI3IZDizxESz1UC5tEuuHs9A94tRiAtdw4DNXSZpAgL52D3xbDO8eKLRLOHDcGajG25jmTYLhBOqfgQIIBbr/I3W7eeOPDsWrZ+T08hrd5Kv7Ly89O3/zhQ4WdHE7vYzoVrNKAWOUgIN9AiupRMApGwSgYCQAAZxpi2sWLbrQAAAAASUVORK5CYII=","orcid":"","institution":"Hir Institute for Research and Development","correspondingAuthor":true,"prefix":"","firstName":"abdulkadir","middleName":"Mohamed","lastName":"Nuh","suffix":""},{"id":395963603,"identity":"8f56f2a3-e49d-4d56-b6e0-9e88c9bc9154","order_by":1,"name":"Abdeta Mukhtar Ahmed","email":"","orcid":"","institution":"Addis ababa Medical","correspondingAuthor":false,"prefix":"","firstName":"Abdeta","middleName":"Mukhtar","lastName":"Ahmed","suffix":""},{"id":395963604,"identity":"74507893-841e-4480-929e-d2e016df107f","order_by":2,"name":"Hamse Arab Ali","email":"","orcid":"","institution":"Addis ababa Medical","correspondingAuthor":false,"prefix":"","firstName":"Hamse","middleName":"Arab","lastName":"Ali","suffix":""},{"id":395963605,"identity":"298c1c93-5f9c-4ce4-803a-8a5c86fc622c","order_by":3,"name":"Hamse Adan Abdi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Hamse","middleName":"Adan","lastName":"Abdi","suffix":""}],"badges":[],"createdAt":"2024-12-30 11:15:05","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5735056/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5735056/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73077531,"identity":"13787006-d2e1-4022-8f47-33d509f9d43f","added_by":"auto","created_at":"2025-01-06 13:41:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":31200,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eNutritional status of hemodialysis patients by using Modified subjective global assessment dialysis malnutrition score among patients undergoing hemodialysis at Hargeisa group Hospital.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5735056/v1/8874eb897852f7c54a44a741.png"},{"id":73078060,"identity":"a4b131e8-9961-4b0e-910c-ca0e061e80d7","added_by":"auto","created_at":"2025-01-06 13:49:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":832933,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5735056/v1/ea0be441-d198-4122-aec7-8d2fae743cbc.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"Assessment of Nutritional Status and Related Factors Among Patients Undergoing Maintenance Hemodialysis at Hargeisa Group Hospital, Somaliland","fulltext":[{"header":"Introduction","content":"\u003ch2\u003eBackground\u003c/h2\u003e\n\u003cp\u003eChronic kidney disease (CKD) presents a burgeoning global health challenge, with increasing prevalence rates internationally. This condition is intrinsically linked to severe repercussions, including kidney failure, cardiac issues, and premature mortality (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), characterized by irreversible renal impairment or a diminished glomerular filtration rate (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). CKD afflicts more than 800\u0026nbsp;million individuals globally. Its prevalence is notably pronounced among older populations and those with inadequately managed diabetes mellitus and hypertension (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs a predominant noncommunicable ailment contributing to global mortality, the incidence of CKD continues to increase, underscoring its increasing importance in the global mortality landscape(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Differences in CKD prevalence across regions suggest variances in population demographics, prevalent noncommunicable diseases, associated comorbidities, and healthcare accessibility (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The nutritional status of chronic kidney disease (CKD) patients varies significantly across different regions, reflecting a complex interplay of socioeconomic, cultural, healthcare, and environmental factors(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Globally, CKD patients often face nutritional challenges, including protein-energy wasting, malnutrition, and metabolic disturbances, which contribute to increased morbidity and mortality rates (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Africa, including sub-Saharan Africa, the nutritional status of CKD patients is particularly concerning due to limited access to healthcare resources, inadequate infrastructure, socioeconomic disparities, and prevalent comorbidities such as infectious diseases, malaria, and HIV/AIDS. These factors exacerbate the nutritional vulnerability of CKD patients, leading to increased rates of malnutrition, micronutrient deficiencies, and associated complications (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNutritional status among patients with chronic kidney disease (CKD) in East African countries, including Somalia, has emerged as a significant concern requiring comprehensive attention(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Several studies conducted across this region have indicated varying degrees of malnutrition prevalence among CKD patients, underscoring the multifaceted challenges faced by this population(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Studies focusing on nutritional status among chronic kidney disease (CKD) patients in Somalia, particularly Somaliland, may not have been widely documented in accessible global databases. However, it is crucial to recognize that nutritional challenges and healthcare infrastructure in these regions might have significant implications for CKD patients' nutritional status (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Although hemodialysis services are being provided to CKD patients at Hargeisa Group Hospital, their association with nutritional status has not been determined.\u003c/p\u003e \u003cp\u003e This study investigated nutritional status and its associated factors among CKD patients on haemodialysis in Hargeisa, Somaliland, to generate evidence for improving patient care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, period, and setting\u003c/h2\u003e \u003cp\u003eAn institution-based cross-sectional study was conducted for four weeks from 30 June to 27 July, 20222, at Hargeisa Group Hospital, Department of Haemodialysis. The hospital was built in 1951 by the British Administration and currently has 400 beds with daily average visitors of more than two hundred and sixty patients with a catchment population of more than one million. It provides health care services for other regions and districts of Somaliland. There are over seven hundred clinical and nonclinical staff members in six main departments. The most recently launched new haemodialysis unit treats varying numbers of patients (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eSample size\u003c/b\u003e: The sample size was calculated via the \u003cb\u003eRAOSOFT\u003c/b\u003e sample size calculator (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) on the basis of the following assumptions: 5% margin of error, 95% confidence level, and response distribution of 50%. The total number of people registered for haemodialysis at the time of data collection was 77.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSampling technique\u003c/strong\u003e \u003cp\u003eA consecutive sampling method was employed to select each study unit because the total number of cases included in the hemodialysis was small.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eData\u003c/b\u003e collection and measurements: Data were collected face-to-face via structured interviewer-administered questionnaires and anthropometric measurements. A structured questionnaire was used to collect sociodemographic data, family history of chronic disease, presence of comorbidities, and risky lifestyle behavior, and dietary practice was assessed via a semiquantitative dietary history method.\u003c/p\u003e \u003cp\u003eTo evaluate the nutritional status of patients with chronic kidney disease (CKD), a quantitative subjective global assessment-dialysis malnutrition score (SGA-DMS) was employed. This assessment tool was adapted from the established SGA framework delineated by Kalantar et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The SGA-DMS encompasses seven distinct components, namely, \u003cb\u003eweight change, dietary intake, gastrointestinal symptoms, functional capability, comorbidities, subcutaneous fat levels, and indications of muscle wasting.\u003c/b\u003e Each of these components is assigned a score ranging from 1 (indicating normal) to 5 (indicating severe malnutrition).\u003c/p\u003e \u003cp\u003eConsequently, the cumulative malnutrition score, derived from the aggregation of scores across all seven components, ranges between 7, indicative of a normal nutritional status, and 35, reflecting severe malnourishment. A lower score denotes a tendency toward a normal nutritional status. A higher score is an indicator of the presence of malnutrition.\u003c/p\u003e \u003cp\u003eFor more \u003cb\u003eoperationalizing the assessment score\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMalnutrition score\u0026thinsp;=\u0026thinsp;sum of all 7 items\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eMinimum score 7\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMaximum 35\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessing nutritional status\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eWell nourished at \u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMildly malnourished\u0026thinsp;\u003cb\u003e\u0026gt;\u0026thinsp;7\u0026thinsp;\u0026lt;\u0026thinsp;21\u003c/b\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eModerately Malnourished \u003cb\u003e21\u0026ndash;34\u003c/b\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSevere Malnutrition \u003cb\u003e35\u003c/b\u003e\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAnthropometric measurements were also taken. The anthropometric measures of weight and height were measured via standard techniques (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Body weight was measured on a digital anthropometric weighing scale. The scale was placed on a squamous flat floor surface. The weighing scales were validated with a known weight object every time and checked against zero readings after every participant was weighed. All patients' weights were measured and taken to the nearest 0.1 kg. Height was measured via a portable stadiometer to the nearest 0.1 cm. Height was measured in all participants, with the weight distributed between the feet, and heels together, in an upright posture, with the head free of props and looking straight ahead at a fixed point at eye level. Body mass index was calculated as weight in kg and height in meters squared on the basis of weight and height. Consequently, the most recent data on laboratory markers, such as \u003cb\u003eserum albumin, serum creatinine, blood urea nitrogen (BUN), haemoglobin (Hb), and blood pressure\u003c/b\u003e, were taken from the files of each patient.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical analysis\u003c/strong\u003e \u003cp\u003eThe collected data were manually checked for completeness and consistency. The data were subsequently entered into SPSS software version 23 for cleaning and analysis. The data were checked for missing values and outliers before analysis. Descriptive statistics were used to examine the frequency distributions of the study variables. A multivariable linear regression model was run to isolate independent predictors of nutritional status among patients with chronic kidney disease. Assumptions for linearity, normality, homoscedasticity and the likelihood of multicollinearity were checked for the model. A P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance. Model fitness was assessed via adjusted R\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eSocioeconomic and demographic characteristics of CKD patients\u003c/h2\u003e\n \u003cp\u003eAmong the 65 participants in the study, 67.3% were males and 32.3% were females. The mean (\u0026plusmn;\u0026thinsp;SD) age was 51.88\u0026thinsp;\u0026plusmn;\u0026thinsp;8.91 years, with a range of 30\u0026ndash;65 years. Only 4.6% were in stage four, whereas 95.6% were in stage five. Nearly 91% of the respondents were married, whereas only 9% were single. With respect to educational level, 38.5% did not attend formal education, whereas 61.5% had different formal education levels, such as primary, secondary, and tertiary levels. A total of 78% of the study participants were unemployed, whereas only 21.5% were employed (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab1\" style=\"width: 365px;\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSocioeconomic and demographic characteristics of CKD patients attending Hargeisa \u003cem\u003eGroup Hospital, Hargeisa, Somaliland, from June 5 to 30 July, 2022 (n\u0026thinsp;=\u0026thinsp;65).\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eCharacteristics of study Participants\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e67.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eAge category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd style=\"width: 84.294px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026le; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd style=\"width: 84.294px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e90.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd style=\"width: 84.294px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e78.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eFamily size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd style=\"width: 84.294px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026le;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026gt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eFormal Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e38.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\" align=\"left\"\u003e\n \u003cp\u003eNone formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136.294px;\" align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.1435px;\" align=\"left\"\u003e\n \u003cp\u003e61.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eDisease-related characteristics of CKD patients\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eDisease-related characteristics of the respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNearly 70% of the respondents reported that they had a family history of chronic diseases, 38.4% had a family history of hypertension only, 4.6% had chronic kidney disease (CKD), and 26% had diabetes mellitus (DM) together with hypertension. Seventy-two percent of the study participants reported that they had other chronic diseases before they suffered from chronic kidney disease (CKD), with 38.3% having hypertension, 32.3% having hypertension with diabetes mellitus and only 4.6% having diabetes mellitus only. With respect to current status, all the respondents reported that they had comorbid conditions. Among those with hypertension (55.3%), 6.2% were diabetic, while 38.5% had both DM and hypertension. In terms of the duration of CKD among patients, 60% of patients had CKD for 2 years or more, whereas 40% had CKD for less than 2 years (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDisease-related characteristics of CKD patients attending Hargeisa Group Hospital, Hargeisa, Somaliland, from June 27 to 30 July, 2022 (n\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics of study Participants\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily history of chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eType of chronic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDM and hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eAny chronic disease before current CKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eType of chronic disease before current CKD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDM and Hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDM only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eStatus of chronic other chronic diseases in the patients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBoth DM and Hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eDuration of CKD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 years and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eRisky lifestyle-related characteristics of CKD patients\u003c/h2\u003e\n \u003cp\u003eMost of the male respondents had a history of tobacco smoking, while there was no history of tobacco smoking among females, but currently, no one smokes tobacco. Ninety-two percent of the respondents had less than twenty minutes of scheduled physical activity before, whereas only 8% had more than twenty minutes. Only 9.2% of patients had exercise plans set with their doctors, whereas the other patients did not. In the current activity, 90% of the study participants were sedentary. In terms of dietary-related characteristics, 32.3% were still dependent on eating foods from restaurants, whereas 67.7% ate special foods prepared in their homes. Although most patients had a low level of salt, only 3.8% consumed the right quantity of salt. Eighty-six percent of the respondents consumed different fruits and vegetables most of the time. A total of 56.9% had experienced anorexia, 39.4% had a loss of appetite most of the time, and 43.1% had no anorexia (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRisk lifestyle-related characteristics of CKD patients at Hargeisa Group Hospital, Hargeisa, Somaliland, June 30 to 27 July 2022 (n\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics of study Participants\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistory of tobacco smoking\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e58.6\u003c/p\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScheduled Physical activities before sick\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;20 minutes\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExercise plan set with your doctor\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003cp\u003e90.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurrent activity\u003c/p\u003e\n \u003cp\u003eSedentary\u003c/p\u003e\n \u003cp\u003eLow activity (\u0026lt;\u0026thinsp;3 km)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e90.7\u003c/p\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEating foods regularly from restaurant\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003cp\u003e67.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEating meat and meat product\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003cp\u003eOnce or twice week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61.5\u003c/p\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSalt consumption\u003c/p\u003e\n \u003cp\u003eRight amount\u003c/p\u003e\n \u003cp\u003eToo small amount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003cp\u003e86.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctor\u0026rsquo;s advice to reduce salt consumption\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e89.2\u003c/p\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConsumption of fruits and vegetables\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e86.2\u003c/p\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency of fruit and vegetable conception\u003c/p\u003e\n \u003cp\u003eMost often\u003c/p\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e72.3\u003c/p\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDietary plan set with doctor\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e93.8\u003c/p\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistory of anorexia\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56.9\u003c/p\u003e\n \u003cp\u003e43.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHow often do you experience loss to appetite\u003c/p\u003e\n \u003cp\u003eMost of the time\u003c/p\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35.4\u003c/p\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eAnthropometric and biochemical markers:\u003c/h3\u003e\n\u003cp\u003eAn increase in the creatinine level indicates impaired kidney function. In the present study, the serum creatinine level of all patients was very high. The mean and standard deviation of the creatinine level were 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42. The level of haemoglobin, which indicates the level of anaemia, was very low, which means that many study participants were anaemic. Among the 65 participants, only 18.5% were underweight, and only 4.6% were overweight, while the rest were normal after calculation of their body mass index (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The mean and standard deviation of diastolic and systolic blood pressure were 156.6\u0026thinsp;\u0026plusmn;\u0026thinsp;21.6 and 112\u0026thinsp;\u0026plusmn;\u0026thinsp;78.2, respectively (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAnthropometric and biochemical marker characteristics of CKD patients at Hargeisa Group Hospital, Hargeisa, Somaliland, from June 30 to 27 July 2022 (n\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eCreatinine level g/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;1.4\u0026thinsp;\u0026lt;\u0026thinsp;8 g/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026ndash;10 g/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;=10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eHaemoglobin value (g/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eFor Females\u003c/p\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;12\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eFor males\u003c/p\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;13\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eBody mass index (BMI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.5\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eStages of CKD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage four\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage five\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eValue (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e156.6\u0026thinsp;\u0026plusmn;\u0026thinsp;21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiastolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e112\u0026thinsp;\u0026plusmn;\u0026thinsp;78.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood urea nitrogen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e131\u0026thinsp;\u0026plusmn;\u0026thinsp;47.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNutritional status of hemodialysis patients by using a modified subjective global assessment of dialysis malnutrition score\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in the figure above (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Over 90% of patients undergoing hemodialysis display indications of malnutrition, predominantly mild to moderate malnutrition. This prevalence of malnutrition among patients undergoing hemodialysis is a matter of significant concern within the healthcare community because malnutrition in this population can exacerbate existing health conditions, compromise immune function, and diminish overall quality of life. Understanding the extent of malnutrition, as highlighted by the figure, underscores the urgency for healthcare providers to prioritize nutritional assessments and interventions for these patients. Early identification and management of malnutrition can potentially improve treatment outcomes, reduce hospitalizations, and increase the overall well-being of individuals undergoing hemodialysis.\u003c/p\u003e\n\u003ch3\u003eMultivariable linear regression model for predicting malnutrition among patients on hemodialysis at Hargeisa Group Hospital\u003c/h3\u003e\n\u003cp\u003eA multivariable linear regression model adjusted for different background characteristics, duration of chronic kidney disease, scheduled physical activity before becoming sick, history of anorexia and hemoglobin level were significantly associated with nutritional status (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Having scheduled physical activities before becoming sick and a history of anorexia and duration of CKD were negatively associated with the \u003cstrong\u003enutritional status of\u003c/strong\u003e patients undergoing hemodialysis (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), whereas the hemoglobin level was positively associated with the nutritional status of CKD patients receiving hemodialysis.\u003c/p\u003e\n\u003cp\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, for a unit increase in the duration of chronic kidney disease, nutritional status decreased by -0.061 (\u0026szlig; = -0.61, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, with a unit increase in the duration of anorexia, nutritional status decreased by -4.746 (\u0026szlig; = -4.746, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); similarly, having any scheduled physical activities before becoming sick decreased the nutritional status of patients on hemodialysis by -4.604 (\u0026szlig; = -4.604, P\u0026thinsp;=\u0026thinsp;0.042). Conversely, an increased haemoglobin level was associated with an increase in nutritional status of 1.463 (\u0026szlig; = 1.463, P\u0026thinsp;=\u0026thinsp;0.014).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate linear regression model for predicting malnutrition among patients on hemodialysis at Hargeisa Group Hospital, Hargeisa, Somaliland\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eUnstandardized Coefficients\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e95.0% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper Bound\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of chronic kidney diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eglomerular filtration rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurrent Activity level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efamily history of chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.859\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.490\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHaving scheduled physical activities before you becoming sick\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-9.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehistory of anorexia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-7.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.300\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003edo you eat fruit and vegetables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.343\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemoglobin level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.623\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eMaximum VIF: 1.692, CI: Confidence interval.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMalnutrition frequently occurs in patients undergoing haemodialysis therapy, often leading to elevated rates of morbidity and mortality (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). On the basis of the modified SGA scoring method, the findings of this study revealed that 92% of the patients presented signs of malnutrition (80% categorized as mild cases and 12% classified as moderate malnutrition). This result was higher than those of similar studies performed in Egypt and Tanzania, which reported values of 85.2% and 61.2%, respectively (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The results of this study were in line with those of another similar study performed in Porur, Chennai, India, in which 91% of patients were mild to moderately malnourished. The quantitative measures of malnutrition showed significant differences between sexes, with males demonstrating a greater prevalence of malnutrition than females did.\u003c/p\u003e \u003cp\u003eThe duration of chronic kidney disease (CKD) can have a significant effect on an individual's nutritional status (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). As CKD progresses over time, it often leads to various metabolic and physiological changes in the body that can affect dietary intake, nutrient metabolism, and overall nutritional well-being (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurther multivariable linear regression analyses revealed that an increased duration of CKD decreased nutritional status because, in the early stages of CKD, individuals may experience subtle changes in appetite, taste alterations, and metabolic disturbances, which can contribute to inadequate nutrient intake (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). As CKD progresses, there may be increased proteinuria, loss of essential nutrients in the urine, and alterations in the body's ability to regulate electrolytes and acid‒base balance, further complicating nutritional status (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). A prolonged duration of CKD is associated with a greater risk of malnutrition due to factors such as decreased protein synthesis, increased protein catabolism, and metabolic acidosis (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, a significant association was observed between a history of anorexia in patients with chronic kidney disease (CKD) and the prevalence of malnutrition. Patients with a prior history of anorexia were at heightened risk of experiencing malnutrition. The occurrence of anorexia among CKD patients can lead to malnutrition due to insufficient dietary intake, resulting in deficiencies in essential nutrients such as protein and calories (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This nutritional deficiency over time can worsen the complications related to CKD, compromise the immune response, hinder wound healing processes, and increase the risk of morbidity and mortality (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, this study revealed a positive relationship between elevated haemoglobin levels and the nutritional status of patients with chronic kidney disease (CKD).\u003c/p\u003e \u003cp\u003eAn increased level of hemoglobin in chronic kidney disease (CKD) patients often signifies improved oxygen-carrying capacity and may have implications for their nutritional status (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Hemoglobin is a vital protein in red blood cells that is responsible for transporting oxygen throughout the body. In CKD patients, an elevated haemoglobin level may indicate effective management of anaemia, a common complication in CKD patients due to reduced erythropoietin production (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMalnutrition is notably prevalent among haemodialysis patients at Hargeisa Group Hospital, particularly among those subjected to extended periods of haemodialysis and those with a history of anorexia. Predominantly, patients exhibited mild to moderate malnutrition. On the basis of these findings, we suggest routine screening of hemodialysis patients to identify malnutrition promptly. Timely and appropriate intervention is imperative, as unaddressed malnutrition may precipitate unfavourable clinical outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval and consent to participants The ethical committee from the research and quality assurance office of the Addis ababa medical university college Hargeisa Campus approved the all procedure used this study. The study was designed and conducted according to the guideline of the declaration of Helsinki. Verbal and written informed consent were obtained from all participants prior to their involvement\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLevey AS, Eckardt KU, Tsukamoto Y et al (2005) Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). 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Nutrients 9(3):208\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaroz N, Simman R (2013) Wound healing in patients with impaired kidney function. J Am Coll Clin Wound Spec 5(1):2\u0026ndash;7\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFang Y, He W (2020) Anemia in chronic kidney disease. Chronic Kidney Disease: Diagnosis Treat. :123\u0026ndash;139\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGityamwi N \u003cem\u003eNutrition, body composition, inflammation and haemoglobin status among haemodialysis patients on Erythropoietin maintenance therapy\u003c/em\u003e (Doctoral dissertation, University of Surrey)\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Hir institute for Research and Development ","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"CKD, nutritional status, haemodialysis, clinical profile","lastPublishedDoi":"10.21203/rs.3.rs-5735056/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5735056/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: Chronic kidney disease (CKD) is a long-term condition characterized by the gradual loss of kidney function over time with a reduction in the glomerular filtration rate. More than 800 million people are affected by chronic kidney diseases worldwide. Its prevalence is notably pronounced among older populations and those with inadequately managed diabetes mellitus and hypertension. Nutritional status among patients with chronic kidney disease (CKD) in East African countries, including Somaliland, has emerged as a significant concern requiring comprehensive attention. Several studies conducted across this region have indicated varying degrees of malnutrition among CKD patients.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eObjective: This study aimed to assess nutritional status and related factors among patients with chronic kidney disease on haemodialysis at Hargeisa Group Hospital, Hargeisa, to generate evidence for practice.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e An institution-based cross-sectional study was conducted for a period of four weeks from 30 June to 27 July 20222 at Hargeisa Group Hospital, Department of Haemodialysis.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: A multivariate linear regression model adjusted for different background characteristics, duration of chronic kidney disease, scheduled physical activity before becoming sick, history of anorexia and hemoglobin level was significantly associated with nutritional status (P \u0026lt; 0.05). For a unit increase in the duration of chronic kidney disease, the SGA-DMS score increased by 0.061 (ß = 0.061, P \u0026lt; 0.001). Similarly, a unit increase in the duration of anorexia (SGA-DMS) score increased by 4.746 (ß = 4.746, P \u0026lt; 0.001), indicating malnutrition. Conversely, having any scheduled physical activity before becoming sick decreased the SGA-DMS score by -4.604 (ß = -4.604, P =0.042). Conversely, a unit increase in the haemoglobin level decreased (SGA-DMS) the score by -1.463 (ß = -1.463, P =0.014).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: Malnutrition is notably prevalent among hemodialysis patients at Hargeisa Group Hospital, particularly among those subjected to extended dialysis and those with a history of anorexia.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Assessment of Nutritional Status and Related Factors Among Patients Undergoing Maintenance Hemodialysis at Hargeisa Group Hospital, Somaliland","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-06 13:41:14","doi":"10.21203/rs.3.rs-5735056/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd9b64d4-cc1d-4ae3-a002-d96246994b6c","owner":[],"postedDate":"January 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":42182003,"name":"Nutrition \u0026 Dietetics"}],"tags":[],"updatedAt":"2025-01-06T13:41:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-06 13:41:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5735056","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5735056","identity":"rs-5735056","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}