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Independent and joint associations of nutritional status indicators with mortality risk among chronic hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS).
J Ren Nutr. 2010 Jul; 20(4):224-34.JR

Abstract

OBJECTIVE

To consider the Kidney Disease Outcomes Quality Initiative recommendation of using multiple nutritional measurements for patients on maintenance dialysis, we explored data for independent and joint associations of nutritional indicators with mortality risk among maintenance hemodialysis patients treated in 12 countries.

SETTING

Dialysis units in seven European countries, the United States, Canada, Australia, New Zealand, and Japan.

MAIN OUTCOME

Mortality risk.

METHODS

We conducted a prospective cohort study of 40,950 patients from phases I to III of the Dialysis Outcomes and Practice Patterns Study (1996-2008). Independent and joint effects (interactions) of nutritional indicators (serum creatinine, serum albumin, normalized protein catabolic rate, body mass index [BMI]) on mortality risk were assessed by Cox regression with adjustments for demographics, years on dialysis, and comorbidities.

RESULTS

Important variations in nutritional indicators were seen by country and patient characteristics. Poorer nutritional status assessed by each indicator was independently associated with higher mortality risk across regions. Significant multiplicative interactions (each p < or = 0.01) between indicators were also observed. For example, by using patients with serum creatinine 7.5-10.5 mg/dL and BMI 21-25 kg/m(2) as referent, BMI <21 kg/m(2) was associated with lower mortality risk among patients with creatinine >10.5 mg/dL (relative risk = 0.68) but with higher mortality risk among those with creatinine <7.5 mg/dL (relative risk = 1.38). The association of lower albumin concentration with higher mortality risk was stronger for patients with lower BMI or lower creatinine.

CONCLUSION

The joint effects of nutritional indicators on mortality indicate the need to use multiple measurements when assessing the nutritional status of hemodialysis patients.

Authors+Show Affiliations

Department of Medicine, Federal University of Bahia, Salvador, BA CEP: 40110-100, Brazil. aaslopes@ufba.brNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20060319

Citation

Lopes, Antonio Alberto, et al. "Independent and Joint Associations of Nutritional Status Indicators With Mortality Risk Among Chronic Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 20, no. 4, 2010, pp. 224-34.
Lopes AA, Bragg-Gresham JL, Elder SJ, et al. Independent and joint associations of nutritional status indicators with mortality risk among chronic hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Ren Nutr. 2010;20(4):224-34.
Lopes, A. A., Bragg-Gresham, J. L., Elder, S. J., Ginsberg, N., Goodkin, D. A., Pifer, T., Lameire, N., Marshall, M. R., Asano, Y., Akizawa, T., Pisoni, R. L., Young, E. W., & Port, F. K. (2010). Independent and joint associations of nutritional status indicators with mortality risk among chronic hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 20(4), 224-34. https://doi.org/10.1053/j.jrn.2009.10.002
Lopes AA, et al. Independent and Joint Associations of Nutritional Status Indicators With Mortality Risk Among Chronic Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Ren Nutr. 2010;20(4):224-34. PubMed PMID: 20060319.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Independent and joint associations of nutritional status indicators with mortality risk among chronic hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). AU - Lopes,Antonio Alberto, AU - Bragg-Gresham,Jennifer L, AU - Elder,Stacey J, AU - Ginsberg,Nancy, AU - Goodkin,David A, AU - Pifer,Trinh, AU - Lameire,Norbert, AU - Marshall,Mark R, AU - Asano,Yasushi, AU - Akizawa,Tadao, AU - Pisoni,Ronald L, AU - Young,Eric W, AU - Port,Friedrich K, Y1 - 2010/01/08/ PY - 2009/06/08/received PY - 2010/1/12/entrez PY - 2010/1/12/pubmed PY - 2010/9/18/medline SP - 224 EP - 34 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 20 IS - 4 N2 - OBJECTIVE: To consider the Kidney Disease Outcomes Quality Initiative recommendation of using multiple nutritional measurements for patients on maintenance dialysis, we explored data for independent and joint associations of nutritional indicators with mortality risk among maintenance hemodialysis patients treated in 12 countries. SETTING: Dialysis units in seven European countries, the United States, Canada, Australia, New Zealand, and Japan. MAIN OUTCOME: Mortality risk. METHODS: We conducted a prospective cohort study of 40,950 patients from phases I to III of the Dialysis Outcomes and Practice Patterns Study (1996-2008). Independent and joint effects (interactions) of nutritional indicators (serum creatinine, serum albumin, normalized protein catabolic rate, body mass index [BMI]) on mortality risk were assessed by Cox regression with adjustments for demographics, years on dialysis, and comorbidities. RESULTS: Important variations in nutritional indicators were seen by country and patient characteristics. Poorer nutritional status assessed by each indicator was independently associated with higher mortality risk across regions. Significant multiplicative interactions (each p < or = 0.01) between indicators were also observed. For example, by using patients with serum creatinine 7.5-10.5 mg/dL and BMI 21-25 kg/m(2) as referent, BMI <21 kg/m(2) was associated with lower mortality risk among patients with creatinine >10.5 mg/dL (relative risk = 0.68) but with higher mortality risk among those with creatinine <7.5 mg/dL (relative risk = 1.38). The association of lower albumin concentration with higher mortality risk was stronger for patients with lower BMI or lower creatinine. CONCLUSION: The joint effects of nutritional indicators on mortality indicate the need to use multiple measurements when assessing the nutritional status of hemodialysis patients. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/20060319/Independent_and_joint_associations_of_nutritional_status_indicators_with_mortality_risk_among_chronic_hemodialysis_patients_in_the_Dialysis_Outcomes_and_Practice_Patterns_Study__DOPPS__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(09)00280-5 DB - PRIME DP - Unbound Medicine ER -