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Nutritional parameters and mortality in incident hemodialysis patients
Isabel Cristina de Araújo1, Maria Ayako Kamimura, Sérgio Antônio Draibe
1Nutrition Program, Federal University of Sao Paulo, Sao Paulo, Brazil.
Insights
Low midarm muscle circumference (MAMC) and energy intake at hemodialysis initiation predict mortality. High BMI negatively impacts survival, especially with reduced MAMC and longer dialysis vintage.
Area of Science:
- Nephrology
- Clinical Nutrition
- Public Health
Background:
- Nutritional status is crucial for patients initiating hemodialysis (HD).
- Understanding early nutritional markers can predict patient outcomes.
- Muscle and fat depletion are common in incident HD patients.
Purpose of the Study:
- To assess the association between nutritional parameters at HD initiation and mortality.
- To identify early nutritional predictors of survival in HD patients.
Main Methods:
- Retrospective study of 344 incident HD patients.
- Baseline nutritional assessments included MAMC, BMI, albumin, and dietary intake.
- Patient outcomes (death) were tracked over 10 years.
Main Results:
- 51% of patients showed muscle/fat depletion.
- Low MAMC adequacy, low protein/energy intake, hypoalbuminemia, diabetes, and age >60 were linked to worse survival.
- Reduced MAMC and low energy intake were independent predictors of death.
Conclusions:
- Reduced midarm muscle circumference (MAMC) and low energy intake are significant risk factors for mortality in early HD.
- High BMI's negative impact on survival is exacerbated by reduced MAMC and longer dialysis vintage.
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.
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