Renal function and nutritional status at the start of chronic dialysis treatment

Early start of dialysis has been hypothesized to prevent deterioration of nutritional status and to lead to a better clinical outcome. According to the National Kidney Foundation/Dialysis Outcomes Quality Initiative guidelines, dialysis should be started when renal Kt/V(urea) falls below 2.0/wk or the protein equivalent of total nitrogen appearance normalized to body weight (nPNA) falls below 0.8 g/kg per d. The present study was performed 0 to 4 wk before the start of dialysis treatment in 114 incident Dutch patients with chronic renal failure who all had received pre-end-stage renal disease care. The objectives were (1) to analyze the relationship of different levels of residual renal function with parameters of nutritional status and (2) to investigate the relationship of renal Kt/V(urea) and nPNA in this population. The mean GFR at the start of dialysis treatment was 6.2 ml/min per 1.73 m(2), and the Kt/V(urea) was 1.3/wk. Only 10% of the patients fulfilled the Dialysis Outcomes Quality Initiative criterion of Kt/V(urea) > 2.0/wk. In contrast, 69% met the nPNA norm of 0.8 g/kg per d. Seventy-one percent of these patients had a normal nutritional status as scored by subjective global assessment and also other parameters of nutritional status, such as body mass index, and serum albumin fell within the normal range in the majority of the patients. Dutch predialysis patients reached a higher nPNA with the same level of Kt/V(urea) compared with U.S. predialysis patients. Implications of these findings are that guidelines on the initiation of dialysis treatment derived from one population are not necessarily valid in other populations.