[Malnutrition and mortality in hemodialyzed patients]

Due to the ageing of the general population and improved techniques, the acceptance rate of patients starting dialysis has increased. Mortality remains high and the factors involved include nutritional parameters, which also seem to be of value for prognosis in this population.

We proposed a prospective study in our haemodialysis population in order to establish the factors with the greatest predictive value for mortality.

One hundred stabilized patients receiving this technique were included in the study, with registration of any concomitant pathologies, their severity and the presence of HBP; we carried out a clinical assessment measuring nutritional parameters and functional capacity, with anthropometric and analytical measurements with dialysis dosage and protein catabolism rate. The observation period lasted for one year. The statistical analysis compared survivors and dead patients by means of a bivariant analysis, and after selecting the significant variables, log regression was applied.

The annual death rate was 15%. The bivariant analysis highlights the greater age and the prevalence of vascular pathology prior to dialysis, with a greater severity score and prior weight loss, as well as a lessened functional capacity and clinical assessment score among the dead patients. The analytical parameters showed lymphocytes to be significantly lower among the deceased. The log regression analysis revealed the predictive value of severity, followed by initial vascular co-morbidity, lymphocyte levels less than 1,200 and the nutritional clinical assessment score.

1. Severity was the main factor predicting mortality. 2. The presence of vascular co-morbidity at the start of dialysis increased the likelihood of death by more than ten times. 3. Lymphopenia of less than 1,200 and low scores in the subjective overall assessment were predictors of mortality.