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Changes in Nutritional Category After the First Year of Dialysis and Their Association With Survival and
Sara Blumberg Benyamini1, Relu Cernes2, Anna Katkov2
1Nephrology and Hypertension Department, E Wolfson Medical Center, Holon, Israel; Department of Clinical Nutrition, E Wolfson Medical Center, Holon, Israel.
Objectives:
To examine nutritional category reclassification at 1 year after hemodialysis initiation and its associations with later survival and hospitalization.
Methods:
A total of 297 patients who started dialysis from March 2009 to March 2019 were enrolled. Nutritional status was assessed at dialysis commencement and 1 year later using the Integrative Clinical Nutrition Dialysis Score along with the slope of 3 successive monthly scores. Patients were classified into four nutritional categories, with category 1 representing the best nutritional status and category 4 the poorest. The Cox proportional hazard model was used to analyze the associations between the nutritional categories at the beginning of the second year on hemodialysis and all-cause mortality. The Kruskal-Wallis rank sum test was used to analyze hospitalization frequency and hospital length of stay (LOS).
Results:
Reclassification to different nutritional categories was observed at 1 year after dialysis initiation. Three years after dialysis initiation, death odds of patients allocated to categories 3 and 4 combined were significantly increased compared to category 1 (HR: 2.71, 95% confidence interval: 1.45-5.07, P = .002). The median LOS of patients in category 1 at 1 year after dialysis start was 1.3 days, (interquartile range (IQR): 0.0-4.7) significantly shorter than that for categories 3 and 4 combined (median 5.0 days, IQR: 3.0-6.0, P = .028). The median number of hospitalizations was lower in category 1 (median 1, IQR: 0-2), compared with categories 3 and 4 combined (median 3, IQR:1-3, P = .009).
Conclusions:
Nutritional category at 1 year after hemodialysis initiation is associated with patients' future survival, hospitalization frequency, and hospital LOS.
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