NDT Advance Access originally published online on September 24, 2007
Nephrology Dialysis Transplantation 2007 22(12):3538-3546; doi:10.1093/ndt/gfm453
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Lack of appetite in haemodialysis patients—associations with patient characteristics, indicators of nutritional status and outcomes in the international DOPPS
1Department of Medicine of the Federal University of Bahia, Salvador, BA, Brazil, 2Arbor Research Collaborative for Health, Ann Arbor, MI, 3Renal Research Institute, New York, NY, USA, 4Universita Federico II, Naples, Italy, 5Nephrology Service, Hospital General Universitario ‘La Fe,’ Valencia, Spain, 6Kyoto University Graduate School of Medicine, Kyoto, 7Tokai University School of Medicine, Isehara, Kanagawa, Japan and 8Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
Correspondence and offprint requests to: Friedrich K. Port, MD, MS, Arbor Research Collaborative for Health, 315 W. Huron, Suite 360, Ann Arbor, MI 48103, USA. Email: friedrich.port{at}ArborResearch.org
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Abstract |
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Background. Identification of haemodialysis patients with problems related to lack of appetite should help prevent adverse outcomes. We studied whether a single question about being bothered by lack of appetite within the prior 4 weeks is related to nutritional status, inflammation and risks of death and hospitalization. Additionally, we assessed associations of lack of appetite with depression, dialysis dose and length of haemodialysis.
Methods. This study is an analysis of baseline and longitudinal data from 14 406 patients enrolled in the Dialysis Outcomes and Practice Pattern Study. Cox regression was used to assess whether the degree (not, somewhat, moderately, very much, extremely) that patients were bothered by lack of appetite is an independent predictor of death and hospitalization. Logistic regression was used to identify baseline characteristics associated with being bothered by lack of appetite.
Results. The risk of death was more than 2-fold higher [relative risk (RR) = 2.23; 95% confidence interval (CI) = 1.90–2.62] and the risk of hospitalization 33% higher (RR = 1.33; 95% CI = 1.19–1.48) among patients extremely bothered, compared with not bothered, by lack of appetite. These associations followed a dose–response fashion and remained statistically significant after adjustments for 14 comorbidities. Depression, shorter haemodialysis session, hypoalbuminaemia, lower concentration of serum creatinine and normalized protein catabolic rate, lower body mass index and higher leucocyte and neutrophil counts were independently associated with higher odds of being bothered by lack of appetite.
Conclusions. The data suggest that a single question about lack of appetite helps identify haemodialysis patients with poorer nutritional status, inflammation, depression and higher risks of hospitalization and death. The study calls attention to a possible beneficial effect of longer haemodialysis on appetite.
Keywords: appetite; depression; haemodialysis; hospitalization; mortality; nutrition
Received for publication: 31.10.06
Accepted in revised form: 12. 6.07
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