Nephrology Dialysis Transplantation, Vol 13, Issue 7 1731-1736, Copyright © 1998 by Oxford University Press
P Arora, B Strauss, D Borovnicar, D Stroud, R Atkins and P Kerr
Background: It has been estimated that 30-50% of adult
haemodialysis patients have moderate to severe malnutrition. We have
previously shown that estimation of total body nitrogen, expressed as a
nitrogen index (NI) by in vivo neutron activation
analysis (IVNAA) is an accurate tool for estimating total body protein in
dialysis patients. It is not clear whether the nitrogen index is predictive
of mortality and morbidity in dialysis patients.
Methods: We studied the long-term predictive value of
nutritional assessment by IVNAA and serum albumin on mortality and
morbidity (including infection episodes requiring hospital admission,
ischaemic heart disease (IHD), cerebrovascular or peripheral vascular
disease (PVD). Seventy-six chronic haemodialysis patients were initially
studied between 1989 and 1991, with a minimum follow-up of 5 years. The
mean age of the patients was 48.3 years (range 21-76). Patients were
divided into two groups, group I, n=22, had a NI⩽0.8
(NI⩽0.8 represents protein malnutrition) and group II, n=54, had a
NI>0.8. Results: Fifteen patients in group II
died in the follow-up period compared to nine from group I (P<0.05),
but NI⩽0.8 did not predict vascular or infective morbidity. Serum
albumin⩽35 g/day did predict over all mortality (P<0.05) as
well as infection episodes (P<0.001). When patients above the age of
50 years were analysed, NI did predict mortality (P<0.05) but serum
albumin did not, while the age of >50 itself was a strong predictor
of mortality (P<0.001). Conclusion: We conclude
that NI⩽0.8 is predictive of long-term mortality. This reinforces
the view that low body protein stores are predictive of increased mortality
in dialysis patients and that the serum albumin is predictive of mortality
because of its reflection of protein stores. Key
words: haemodialysis; mortality; nutrition; total body nitrogen
ORIGINAL ARTICLES
Total body nitrogen predicts long-term mortality in haemodialysis patients - a single-centre experience
Nephrology Unit and Body Composition Laboratory, Monash Medical Centre, Clayton, Victoria, Australia; Corresponding author
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