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Nutritional predictors of early mortality in incident hemodialysis patients

  • Nephrology - Original Paper
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Abstract

Purpose

Low serum albumin concentration and low dietary protein intake are associated with protein-energy wasting (PEW) and higher mortality in maintenance hemodialysis patients. The role of these nutritional markers is less clear in clinical outcomes of the first several months of dialysis therapy, where mortality is exceptionally high.

Methods

In a cohort of 17,445 incident hemodialysis patients, we examined variation in serum albumin and the normalized protein catabolic rate (nPCR), a surrogate of dietary intake, and quarterly mortality in the first 2 years of dialysis therapy. Cox proportional hazard models were fitted to estimate the association between mortality and combined albumin/nPCR categories for eight quarters. We investigated the associations between mortality and baseline and subsequent serum albumin levels per cohort quarter as well as changes in albumin and nPCR over time.

Results

Patients were 64 ± 15 years old (mean ± SD) and included 45 % women, 24 % African Americans and 58 % diabetics. Correlations between quarterly serum albumin and nPCR varied from 0.18 to 0.25. Serum albumin <3.5 g/dL was consistently associated with high mortality as was nPCR <1 g/kg/day (except for qtr1). Low serum albumin and nPCR greater than 0.2 g/dLg/dL or g/kg/day, respectively, were associated with increased risk of death. Quarterly rise in nPCR (>+0.2 g/kg/day) showed reverse effect on mortality from the 2nd to the last quarter.

Conclusions

Low serum albumin and nPCR are associated with mortality. A rapid rise in nPCR by the end of the second year may indicate pre-existing PEW.

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Acknowledgments

We thank DaVita Clinical Research® (DCR) for providing the clinical data, analysis, and review for this research project and for advancing the knowledge and practice of kidney care. The study was supported by a research grant from the National Institute of Diabetes, Digestive and Kidney Disease of the National Institutes of Health R01 DK078106, a philanthropist grant from Mr. Harold Simmons and a research grant from DaVita Clinical Research. OAA was supported by a Veni career grant # 916.96.059 from the Netherlands Organization for Scientific Research (NWO).

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, CA, 90509-2910, USA

    Lilia R. Lukowsky & Kamyar Kalantar-Zadeh

  2. Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Lilia R. Lukowsky, Leeka Kheifets, Onyebuchi A. Arah & Kamyar Kalantar-Zadeh

  3. Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Onyebuchi A. Arah

  4. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Allen R. Nissenson & Kamyar Kalantar-Zadeh

  5. DaVita, Inc, El Segundo, CA, USA

    Allen R. Nissenson

Authors
  1. Lilia R. Lukowsky
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  2. Leeka Kheifets
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  3. Onyebuchi A. Arah
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  4. Allen R. Nissenson
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  5. Kamyar Kalantar-Zadeh
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Corresponding author

Correspondence to Kamyar Kalantar-Zadeh.

Additional information

This manuscript served as the main component of the doctoral thesis of Dr. Lilia R Lukowsky for a PhD degree in Epidemiology at UCLA School of Public Health. Other co-authors are the members of the thesis committee.

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Lukowsky, L.R., Kheifets, L., Arah, O.A. et al. Nutritional predictors of early mortality in incident hemodialysis patients. Int Urol Nephrol 46, 129–140 (2014). https://doi.org/10.1007/s11255-013-0459-2

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  • DOI: https://doi.org/10.1007/s11255-013-0459-2

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