Nutritional Parameters and Mortality in Incident Hemodialysis Patients

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.