Nutritional parameters and mortality in incident hemodialysis patients

Abstract

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 < 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 < 90% showed the best survival over the study period, and those with BMI < 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. © 2006 by the National Kidney Foundation, Inc.