# Malnutrition among patients with end-stage renal disease in war 2024: the role of healthcare access, dialysis, gender, and economic disparities

## TL;DR

This study finds that many end-stage renal disease patients in northern Sudan suffer from malnutrition, linked to healthcare access, gender, and economic factors.

## Contribution

The study identifies specific predictors of malnutrition in war-affected regions and emphasizes the role of healthcare access and socio-economic disparities.

## Key findings

- 44% of patients had mild to moderate malnutrition, and 4.3% had severe malnutrition.
- Female gender and dialysis duration over 5 years were significant predictors of malnutrition.
- Better healthcare access was associated with improved nutritional status.

## Abstract

End-stage renal disease patients on haemodialysis are at risk of malnutrition, leading to poor clinical outcomes. This multifaceted issue is expected to worsen due to the ongoing war and displacement crisis. This study aimed to identify the prevalence and factors that contribute to malnutrition among these patients in northern Sudan.

This cross-sectional study recruited 141 patients from four public haemodialysis centres in the Northern State by cluster sampling. Socioeconomic and clinical data were collected through interviews. Nutritional status was assessed using Subjective Global Assessment (SGA), while healthcare access was evaluated based on Penchansky and Thomas model. Descriptive, bivariate and multivariate analyses were performed using the Statistical Package for Social Science (SPSS) v21, with the statistical significance set at p-value < 0.05.

Most of the patients were males (68.1%), and the mean age was 52 ± 14.5 years. Mild to moderate malnutrition was observed in 44% of the patients, and severe malnutrition in 4.3%. Female gender (OR = 2.29, 95% CI = 1.04–5.07) and dialysis duration over 5 years (OR = 2.95, 95% CI = 1.16–7.51) predicted malnutrition. Better healthcare access was associated with better nutritional status (p-value < 0.05). Lower income, urban residence, hypertension, and cardiopathy were linked to worse nutritional scores.

The study reveals a high prevalence of malnutrition in haemodialysis patients, with a significant contribution of iatrogenic factors, symptomatic burden, healthcare access, and socio-economic disparities. We recommend an integrated healthcare approach that addresses regular nutritional monitoring, symptom management, and socio-economic support.