Altered taste perception, sodium load, and malnutrition: the clinical significance of metallic taste perception in hemodialysis patients.

Introduction: altered taste perception, appetite loss, and dietary non-compliance are common complications in hemodialysis patients (HD) that contribute to protein-energy wasting (PEW) and poor nutritional status. Objective: this study investigated the relationships between altered taste perception (altTP), appetite status, and nutritional parameters in HD patients, particularly in relation to PEW, based on the Malnutrition Inflammation Score (MIS). Methods: a total of 70 HD patients were included. PEW was classified using MIS. Taste perception was evaluated subjectively, appetite was measured using the Appetite and Diet Assessment Tool (ADAT), and fluid/dietary compliance was assessed with the Dialysis Diet and Fluid Non-adherence Questionnaire (DDFQ). Anthropometric data, dietary intake, and biochemical markers were recorded. Results: according to MIS, 31.4 % of patients were classified as PEW. Patients reporting altered taste, especially those perceiving a metallic taste, had significantly higher MIS scores and dietary sodium intake, while showing lower dry weight and total iron-binding capacity (TIBC) (p < 0.05). A significant positive correlation was found between zinc and albumin levels (r  =  0.422, p  =  0.001). Logistic regression analysis showed that, changes in appetite and non-adherence to diet were positively associated with MIS, while MUAC, serum albumin, TIBC, and daily energy intake were negatively associated. Conclusion: the findings underscore the clinical importance of altered taste, particularly metallic taste, and appetite loss as indicators of nutritional risk in HD patients. These sensory changes are strongly associated with key markers of PEW, suggesting the need for early identification and nutritional intervention in this population.