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NDT Advance Access published online on July 15, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp346
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance

Roman Fiedler1, Peter M. Jehle2, Bernd Osten1, Otgontogoo Dorligschaw1 and Matthias Girndt1

1 Department of Internal Medicine II, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Sachsen-Anhalt 2 Department of Internal Medicine, Paul-Gerhardt-Stift-Krankenhaus, Lutherstadt Wittenberg, Germany

Correspondence and offprint requests to: Roman Fiedler; E-mail: roman.fiedler{at}medizin.uni-halle.de



  Abstract

Background. Malnutrition is closely related to inflammation and atherosclerosis in uraemic patients. There is still debate on how to quantify nutritional status in order to achieve the best prediction of mortality and hospitalization.

Methods. Different methods to detect malnutrition were prospectively investigated for their prognostic impact on mortality and hospitalization of haemodialysis (HD) patients. We compared clinical nutrition scores (body mass index, BMI; subjective global assessment, SGA; malnutrition inflammation score, MIS; and nutritional risk screening, NRS) to lab parameters of protein and lipid metabolism, or bioelectrical impedance analysis (BIA) in 90 HD patients. Over a 3-year follow-up, all-cause mortality and hospitalization were evaluated using a Cox regression model.

Results. The scores SGA, NRS, MIS, serum albumin, prealbumin, transferrin and BIA were predictive of both mortality and hospitalization. Elevated CRP predicted only a significantly higher mortality. After adjustment for age, gender, dialysis vintage and diabetes status, the best prognostic parameters for mortality were the clinical nutrition scores, MIS-Index ≥ 10 [HR 6.25 (2.82–13.87), P < 0.001], NRS [HR 4.24 (1.92–9.38), P < 0.001] and SGA B/C [HR 2.70 (1.14–6.41), P < 0.05].

Conclusions. In HD patients, serum markers of protein metabolism and BIA can be used for evaluation of the nutritional status. However, with regard to mortality and hospitalization risk, the individual clinical nutrition scores are superior compared to lab markers and BIA. To confirm malnutrition, we propose using clinical nutrition score generally or at least in the case of two malnutrition-positive parameters (lab, BIA, BMI).

Keywords: bioelectrical impedance; haemodialysis; hospitalization; mortality; nutritional status

Received for publication: 1. 3.09
Accepted in revised form: 23. 6.09


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