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Morbidity and mortality in hemodialysis patients
S R Acchiardo1, L W Moore, L Burk
1Department of Medicine, University of Tennessee, Memphis.
Insights
Hemodialysis patients with inadequate protein intake experienced higher hospitalization and mortality rates. Urea kinetics (UK) monitoring is crucial for optimizing dialysis prescription and patient outcomes in hemodialysis care.
Area of Science:
- Nephrology
- Internal Medicine
- Clinical Nutrition
Background:
- Rising mortality rates in US hemodialysis patients present a significant clinical concern.
- Understanding the relationship between nutritional status and patient outcomes is essential for improving care.
Purpose of the Study:
- To analyze the morbidity and mortality of hemodialysis patients based on nutritional status.
- To evaluate the effectiveness of urea kinetics (UK) in assessing dialysis adequacy and patient outcomes.
Main Methods:
- Annual mortality rates from 1981-1989 were determined.
- Morbidity and mortality of 136 hemodialysis patients in 1988 were analyzed using urea kinetics (UK).
- Patients were categorized into groups based on protein catabolic rate (pcr) and blood urea nitrogen (BUN) levels.
Main Results:
- Patients with inadequate protein intake (Group 1) had significantly lower BUN, creatinine, hematocrit, and serum albumin.
- Group 1 also exhibited higher rates of hospitalization and longer hospital stays compared to other groups.
- Mortality rate was 8% in Group 1 versus 4.4% in Group 2 (adequate dialysis).
Conclusions:
- Inadequate protein intake in hemodialysis patients is associated with increased morbidity and mortality.
- Urea kinetics (UK) provides valuable parameters for assessing dialysis adequacy and patient nutritional status.
- Optimizing dialysis prescription through UK monitoring is vital for managing mortality rates in hemodialysis patients.
Abstract:
Increase in mortality in hemodialysis patients in the United States is a rising concern. In this study, the annual mortality rate from 1981 to 1989 was determined and the morbidity and mortality of 136 patients dialyzed during 1988 was analyzed. All patients were followed with urea kinetics (UK). Patients were divided according to NCDS mapping of BUN and protein catabolic rate (pcr): Group 1, inadequate protein intake (n = 28); Group 2, adequate dialysis (n = 51); Group 3, excessive dialysis (n = 28); Group 4, undefined domain (n = 13); and Group 5, transitional domain (n = 16). The UK parameters measured were midweek predialysis BUN, pcr, and Kt/V. Group 1 by definition had the lowest pcr (0.7 g/kg/day vs. greater than 1.0 in the other groups). Patients in Group 1 had significantly lower BUN, creatinine, hematocrit, and serum albumin. Results of all other laboratory tests were not significantly different. Numbers of hospitalizations and days in the hospital were higher in Group 1. Causes of hospitalization were similar in all groups. Mortality rate was 8% in Group 1 vs. 4.4% in Group 2. Dialysis prescription using UK has maintained the annual mortality rate at about 14% for the past nine years.