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Nutritional parameters and mortality in incident hemodialysis patients.
J Ren Nutr. 2006 Jan; 16(1):27-35.JR

Abstract

OBJECTIVE

To evaluate the impact of nutritional parameters at the time of initiation of hemodialysis (HD) on mortality.

DESIGN

Retrospective study.

SETTING

Dialysis Unit of the Federal University of Sao Paulo, Oswaldo Ramos Foundation.

PATIENTS

Three hundred forty-four incident HD patients (60.5% male, 26% diabetic) with the first nutritional evaluation performed before completing 3 months of onset of HD were included.

METHODS

The study consisted of baseline measurements of several nutritional parameters (triceps skinfold thickness [TSF], midarm muscle circumference [MAMC], body mass index [BMI], serum albumin, serum creatinine, and protein and energy intake assessed by 3-day food diary) and records of outcome (death) over a period of 10 years.

RESULTS

Muscle and/or fat depletion was observed in 51% of the studied patients, according to the percent standard of MAMC and TSF, respectively. Presence of diabetes, age over 60 years, serum albumin < 3.5 g/dL, MAMC adequacy < 90%, protein intake < 1.0 g/kg/d, and energy intake < 25 kcal/kg/d were associated with worse survival. When patients were analyzed according to tertiles of dialysis vintage, BMI > or = 25 (calculated as kg/m2) had a negative impact on survival only in the highest tertile (> 2.45 years). Patients with BMI < 25 and MAMC adequacy > or = 90% showed the best survival over the study period, and those with BMI > or = 25 but MAMC adequacy < 90% had the worst survival (P = .004). In the multivariate survival analysis adjusting for diabetes, advanced age, and hypoalbuminemia, the reduced MAMC (P = .008) and the low energy intake (P = .03) were independent predictors of death in incident HD patients.

CONCLUSIONS

Reduced MAMC and low energy intake at the beginning of chronic dialysis are risk factors for mortality. A negative effect of high BMI on survival was associated with reduced MAMC and longer dialysis vintage.

Authors+Show Affiliations

Nutrition Program, Federal University of Sao Paulo, Sao Paulo, Brazil.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16414438

Citation

Araújo, Isabel Cristina de, et al. "Nutritional Parameters and Mortality in Incident Hemodialysis Patients." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 16, no. 1, 2006, pp. 27-35.
Araújo IC, Kamimura MA, Draibe SA, et al. Nutritional parameters and mortality in incident hemodialysis patients. J Ren Nutr. 2006;16(1):27-35.
Araújo, I. C., Kamimura, M. A., Draibe, S. A., Canziani, M. E., Manfredi, S. R., Avesani, C. M., Sesso, R., & Cuppari, L. (2006). Nutritional parameters and mortality in incident hemodialysis patients. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 16(1), 27-35.
Araújo IC, et al. Nutritional Parameters and Mortality in Incident Hemodialysis Patients. J Ren Nutr. 2006;16(1):27-35. PubMed PMID: 16414438.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nutritional parameters and mortality in incident hemodialysis patients. AU - Araújo,Isabel Cristina de, AU - Kamimura,Maria Ayako, AU - Draibe,Sérgio Antônio, AU - Canziani,Maria Eugênia Fernandes, AU - Manfredi,Silvia Regina, AU - Avesani,Carla Maria, AU - Sesso,Ricardo, AU - Cuppari,Lilian, PY - 2005/06/07/received PY - 2006/1/18/pubmed PY - 2006/9/23/medline PY - 2006/1/18/entrez SP - 27 EP - 35 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 16 IS - 1 N2 - OBJECTIVE: To evaluate the impact of nutritional parameters at the time of initiation of hemodialysis (HD) on mortality. DESIGN: Retrospective study. SETTING: Dialysis Unit of the Federal University of Sao Paulo, Oswaldo Ramos Foundation. PATIENTS: Three hundred forty-four incident HD patients (60.5% male, 26% diabetic) with the first nutritional evaluation performed before completing 3 months of onset of HD were included. METHODS: The study consisted of baseline measurements of several nutritional parameters (triceps skinfold thickness [TSF], midarm muscle circumference [MAMC], body mass index [BMI], serum albumin, serum creatinine, and protein and energy intake assessed by 3-day food diary) and records of outcome (death) over a period of 10 years. RESULTS: Muscle and/or fat depletion was observed in 51% of the studied patients, according to the percent standard of MAMC and TSF, respectively. Presence of diabetes, age over 60 years, serum albumin < 3.5 g/dL, MAMC adequacy < 90%, protein intake < 1.0 g/kg/d, and energy intake < 25 kcal/kg/d were associated with worse survival. When patients were analyzed according to tertiles of dialysis vintage, BMI > or = 25 (calculated as kg/m2) had a negative impact on survival only in the highest tertile (> 2.45 years). Patients with BMI < 25 and MAMC adequacy > or = 90% showed the best survival over the study period, and those with BMI > or = 25 but MAMC adequacy < 90% had the worst survival (P = .004). In the multivariate survival analysis adjusting for diabetes, advanced age, and hypoalbuminemia, the reduced MAMC (P = .008) and the low energy intake (P = .03) were independent predictors of death in incident HD patients. CONCLUSIONS: Reduced MAMC and low energy intake at the beginning of chronic dialysis are risk factors for mortality. A negative effect of high BMI on survival was associated with reduced MAMC and longer dialysis vintage. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/16414438/Nutritional_parameters_and_mortality_in_incident_hemodialysis_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(05)00174-3 DB - PRIME DP - Unbound Medicine ER -