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. 2014 Jan;46(1):129-40.
doi: 10.1007/s11255-013-0459-2. Epub 2013 May 24.

Nutritional predictors of early mortality in incident hemodialysis patients

Lilia R Lukowsky  1 , Leeka Kheifets, Onyebuchi A Arah, Allen R Nissenson, Kamyar Kalantar-Zadeh
Affiliations

Nutritional predictors of early mortality in incident hemodialysis patients

Lilia R Lukowsky et al. Int Urol Nephrol. 2014 Jan.

Abstract

Purpose: Low serum albumin concentration and low dietary protein intake are associated with protein-energy wasting (PEW) and higher mortality in maintenance hemodialysis patients. The role of these nutritional markers is less clear in clinical outcomes of the first several months of dialysis therapy, where mortality is exceptionally high.

Methods: In a cohort of 17,445 incident hemodialysis patients, we examined variation in serum albumin and the normalized protein catabolic rate (nPCR), a surrogate of dietary intake, and quarterly mortality in the first 2 years of dialysis therapy. Cox proportional hazard models were fitted to estimate the association between mortality and combined albumin/nPCR categories for eight quarters. We investigated the associations between mortality and baseline and subsequent serum albumin levels per cohort quarter as well as changes in albumin and nPCR over time.

Results: Patients were 64 ± 15 years old (mean ± SD) and included 45 % women, 24 % African Americans and 58 % diabetics. Correlations between quarterly serum albumin and nPCR varied from 0.18 to 0.25. Serum albumin <3.5 g/dL was consistently associated with high mortality as was nPCR <1 g/kg/day (except for qtr1). Low serum albumin and nPCR greater than 0.2 g/dLg/dL or g/kg/day, respectively, were associated with increased risk of death. Quarterly rise in nPCR (>+0.2 g/kg/day) showed reverse effect on mortality from the 2nd to the last quarter.

Conclusions: Low serum albumin and nPCR are associated with mortality. A rapid rise in nPCR by the end of the second year may indicate pre-existing PEW.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Fig. 1
Fig. 1. Mean serum levels of albumin and nPCR for each of the 8 quarters in cohort by survival by the end of the qtr compared to mean baseline values for the same group and changes in means from baseline to each quarter by survival; N = 17,745
Fig. 2
Fig. 2. Hazard ratios of death comparing combined Alb/nPCR categories or the first 8 quarters (24 months) of dialysis treatment among incident hemodialysis patients from 5-year DaVita cohort; 07/01-06/06
Fig. 3
Fig. 3
Change in the mean serum levels of ALB and nPCR from the previous quarter to the quarter of interest separately for alive (black) patients and those who died during the quarter (gray) (a, c) and Hazard ratios of death comparing increase and decrease in serum levels to no change (b, d) for incident dialysis patients from 5-year DaVita cohort; 07/01-06/06
See this image and copyright information in PMC

References

    1. Beto J. Improving first-year mortality in patients on dialysis: a focus on nutrition and exercise. Nephrol Nurs J. 2010;37(1):61–65. 98. - PubMed
    1. Kaysen GA, Dubin JA, Muller HG, Mitch WE, Rosales LM, Levin NW. Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients. Kidney Int. 2002;61(6):2240–2249. doi: 10.1046/j.1523-1755.2002.00076.x. - DOI - PubMed
    1. Meuwese CL, Stenvinkel P, Dekker FW, Carrero JJ. Monitoring of inflammation in patients on dialysis: forewarned is forearmed. Nat Rev Nephrol. 2011;7(3):166–176. - PubMed
    1. Kaysen GA, Chertow GM, Adhikarla R, Young B, Ronco C, Levin NW. Inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients. Kidney Int. 2001;60(1):333–340. doi: 10.1046/j.1523-1755.2001.00804.x. - DOI - PubMed
    1. de Mutsert R, Grootendorst DC, Indemans F, Boeschoten EW, Krediet RT, Dekker FW. Association between serum albumin and mortality in dialysis patients is partly explained by inflammation, and not by malnutrition. J Ren Nutr. 2009;19(2):127–135. doi: 10.1053/j.jrn.2008.08.003. - DOI - PubMed

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