Nephrology Dialysis Transplantation, Vol 12, Issue 11 2324-2331, Copyright © 1997 by Oxford University Press
R Marcen, J Teruel, M de la Cal, C Gamez and t Spanish Cooperative Study of Nutrition in Hemodialysis
Background: When assessed by single biochemical
measurements, malnutrition in dialysis patients is associated with
increased mortality, but there are few data evaluating abnormalities in
anthropometry or composite nutritional scores and outcome. The aim of our
study was to ascertain the prevalence and severity of malnutrition in 761
stable patients from 20 haemodialysis centres and its influence in
morbidity and mortality after one year of follow-up.
Methods: Malnutrition was estimated by scoring four
anthropometric indexes; body mass index (BMI), triceps skinfold thickness
(TSF), mid-arm circumference (MAC), and mid-arm muscle circumference
(MAMC); three biochemical measurements; serum albumin, serum transferrin
and total lymphocytes count; and clinical examination. Mortality and
hospitalizations were collected prospectively during the year of follow-up.
Results: A moderate/severe degree of malnutrition was
presented by 51.6% of male and 46.3% of female patients. TSF was
moderate-severely decreased in 41% without differences between males and
females. MAMC was moderately decreased in 19.8% of males and in 8.1% of
females (P <0.001). Multiple logistic regression analysis showed
that the predictors of malnutrition were: age >65 years (OR=1.96,
CI: 1.22-3.14), male sex (OR=1.85, CI: 1.24-3.07), comorbidity index
(OR=1.23, CI: 1.03-1.45), time on dialysis (OR=1.13, CI: 1.08-1.18),
duration of dialysis (OR=0.73, CI: 0.63-0.85) and PCR related to ideal body
weight (OR=0.17, CI: 0.06-0.50). After 1 year of follow-up, data from 442
patients were available. A total of 68 patients died (15.4%) with
cardiovascular diseases being the most frequent cause of death (57.3% of
the cases). The predictors of mortality were: age (OR=1.06, CI: 1.03-1.09)
cardiovascular disease (OR=2.13, CI: 1.19-3.83), neurological disease
(OR=2.96, CI: 1.41-6.15) nephroangiosclerosis (OR=2.31, CI: 1.10-4.98) and
total lymphocyte count (OR=0.93, CI: 0.87-0.98). Hospitalization was needed
in 44% of patients. The comorbidity index, serum albumin and age were the
predictive factors of hospitalization. Conclusions:
Protein-calorie malnutrition is frequent in haemodialysis patients. Fat
depletion predominated in both sexes. Duration of dialysis and protein
catabolic rate related to ideal body weight was the only predictor which
could be influenced by a nutritional intervention. Morbidity appeared to be
influenced by the comorbidity index and age was the strongest predictor of
mortality. The only nutritional measurements predictive of morbidity and
mortality were serum albumin and total lymphocyte count respectively.
Therefore, the influence of malnutrition in morbidity and mortality can not
be definitively stated. Key words: haemodialysis;
hospitalization rate; malnutrition; mortality; protein catabolic rate
ORIGINAL ARTICLES
The impact of malnutrition in morbidity and mortality in stable haemodialysis patients
Department of Nephrology, Hospital Ramon y Cajal, Ctra Colmenar Viejo Km 9.1, 28034 Madrid, Spain; Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain
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