Tags

Type your tag names separated by a space and hit enter

Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients.
J Am Soc Nephrol. 2002 Jan; 13 Suppl 1:S28-36.JA

Abstract

Various studies suggest a strong association between nutrition and clinical outcome in hemodialysis (HD) patients. Several morbidity factors that per se increase the risk of a poor outcome, such as cardiovascular disease (CVD) and inflammation, may also cause malnutrition. Among laboratory parameters used to assess nutritional status, serum albumin appears to be a particularly strong predictor of morbidity and mortality. This study assessed the importance of nutritional status and inflammation and other comorbidity factors as predictors of mortality in HD patients. Nutritional status was evaluated in 128 HD patients by subjective global nutritional assessment (SGNA) and by measuring several anthropometric markers (actual body weight, percentage of actual body weight to desirable body weight, midarm muscle circumferences, triceps skinfold thickness), and serum albumin, plasma insulin such as insulin growth factor-1 and as a marker of inflammation, serum C-reactive protein (s-CRP) levels. The mortality during the next 36 mo was analyzed in relation to age, gender, CVD, SGNA, serum albumin, CRP, and several other factors by Kaplan-Meier analysis multivariate. Cox proportional hazard analysis was used to identify independent predictors of mortality. After 36 mo, 58 patients were still on HD treatment, 57 patients (45%) had died while receiving treatment, and 13 had received a kidney transplant. The main cause of death was CVD (58%), followed by infection (18%); malnutrition/cachexia was a rare direct cause of death (5%). Kaplan-Meier analysis showed that age, female gender, CVD, diabetes, SGNA, all anthropometric parameters, serum albumin, plasma insulinlike growth factor-1, and s-CRP were significant predictors of mortality. Analysis by the Cox model showed that age, gender, CVD, nutritional status (SGNA), and CRP were independent predictors of mortality at 36 mo. A low albumin level was not an independent predictor, although it was strongly associated with a reduced survival rate in the Kaplan-Meier analysis. Inflammation, malnutrition, and CVD appeared to contribute to increased mortality in a stepwise manner. The mortality at 36 mo was 0% when none of these complications was present, whereas the mortality was 75% in those patients with all three risk factors present at baseline. It is concluded that in addition to malnutrition and comorbidities (CVD, diabetes mellitus), inflammation (elevated s-CRP) is a significant independent risk factor for mortality in HD patients. Inflammation, malnutrition, and CVD appear to be interrelated, each additionally contributing to the high mortality in these patients.

Authors+Show Affiliations

Division of Baxter Novum, Department of Clinical Science, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11792759

Citation

Qureshi, A Rashid, et al. "Inflammation, Malnutrition, and Cardiac Disease as Predictors of Mortality in Hemodialysis Patients." Journal of the American Society of Nephrology : JASN, vol. 13 Suppl 1, 2002, pp. S28-36.
Qureshi AR, Alvestrand A, Divino-Filho JC, et al. Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients. J Am Soc Nephrol. 2002;13 Suppl 1:S28-36.
Qureshi, A. R., Alvestrand, A., Divino-Filho, J. C., Gutierrez, A., Heimbürger, O., Lindholm, B., & Bergström, J. (2002). Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients. Journal of the American Society of Nephrology : JASN, 13 Suppl 1, S28-36.
Qureshi AR, et al. Inflammation, Malnutrition, and Cardiac Disease as Predictors of Mortality in Hemodialysis Patients. J Am Soc Nephrol. 2002;13 Suppl 1:S28-36. PubMed PMID: 11792759.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients. AU - Qureshi,A Rashid, AU - Alvestrand,Anders, AU - Divino-Filho,José C, AU - Gutierrez,Alberto, AU - Heimbürger,Olof, AU - Lindholm,Bengt, AU - Bergström,Jonas, PY - 2002/1/17/pubmed PY - 2002/3/7/medline PY - 2002/1/17/entrez SP - S28 EP - 36 JF - Journal of the American Society of Nephrology : JASN JO - J Am Soc Nephrol VL - 13 Suppl 1 N2 - Various studies suggest a strong association between nutrition and clinical outcome in hemodialysis (HD) patients. Several morbidity factors that per se increase the risk of a poor outcome, such as cardiovascular disease (CVD) and inflammation, may also cause malnutrition. Among laboratory parameters used to assess nutritional status, serum albumin appears to be a particularly strong predictor of morbidity and mortality. This study assessed the importance of nutritional status and inflammation and other comorbidity factors as predictors of mortality in HD patients. Nutritional status was evaluated in 128 HD patients by subjective global nutritional assessment (SGNA) and by measuring several anthropometric markers (actual body weight, percentage of actual body weight to desirable body weight, midarm muscle circumferences, triceps skinfold thickness), and serum albumin, plasma insulin such as insulin growth factor-1 and as a marker of inflammation, serum C-reactive protein (s-CRP) levels. The mortality during the next 36 mo was analyzed in relation to age, gender, CVD, SGNA, serum albumin, CRP, and several other factors by Kaplan-Meier analysis multivariate. Cox proportional hazard analysis was used to identify independent predictors of mortality. After 36 mo, 58 patients were still on HD treatment, 57 patients (45%) had died while receiving treatment, and 13 had received a kidney transplant. The main cause of death was CVD (58%), followed by infection (18%); malnutrition/cachexia was a rare direct cause of death (5%). Kaplan-Meier analysis showed that age, female gender, CVD, diabetes, SGNA, all anthropometric parameters, serum albumin, plasma insulinlike growth factor-1, and s-CRP were significant predictors of mortality. Analysis by the Cox model showed that age, gender, CVD, nutritional status (SGNA), and CRP were independent predictors of mortality at 36 mo. A low albumin level was not an independent predictor, although it was strongly associated with a reduced survival rate in the Kaplan-Meier analysis. Inflammation, malnutrition, and CVD appeared to contribute to increased mortality in a stepwise manner. The mortality at 36 mo was 0% when none of these complications was present, whereas the mortality was 75% in those patients with all three risk factors present at baseline. It is concluded that in addition to malnutrition and comorbidities (CVD, diabetes mellitus), inflammation (elevated s-CRP) is a significant independent risk factor for mortality in HD patients. Inflammation, malnutrition, and CVD appear to be interrelated, each additionally contributing to the high mortality in these patients. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/11792759/Inflammation_malnutrition_and_cardiac_disease_as_predictors_of_mortality_in_hemodialysis_patients_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=11792759 DB - PRIME DP - Unbound Medicine ER -