Nutritional Predictors of All-Cause Mortality in Hemodialysis Patients

Patients with end-stage renal disease require close monitoring of nutrition. However, in patients on hemodialysis, obtaining adequate nutritional status while avoiding fluid overload, hyperphosphatemia, and hyperkalemia is difficult. Researchers in Korea conducted a retrospective cohort study to examine the clinical significance of serum albumin and other nutritional markers in patients on maintenance hemodialysis.

The cohort included patients who received hemodialysis for more than 3 months from 2016 to March 2019; patients who died within 30 days were excluded. The study examined the factors associated with all-cause mortality and major adverse cardiovascular events, as well as factors related to sarcopenia (defined as skeletal muscle mass index ≤10.75 kg/m² [men] or ≤6.75 kg/m² [women]).

The total cohort included 284 patients; of those, 63.7% were men, mean age was 64.2 years, and mean body mass index (BMI) was 23.7 kg/m². The most common underlying diseases were hypertension and diabetes. Median follow-up was 16.7 months. During follow-up, 39 patients (13.7%) experienced a major cardiovascular adverse event and 35 patients (12.3%) died.

Results of multivariate Cox analyses demonstrated significant associations between all-cause mortality and lower albumin, higher C-reactive protein level, and history of cardiovascular disease. There was a significant positive correlation between skeletal muscle mass index and BMI, serum phosphorus, blood urea nitrogen, creatinine, and uric acid level.

In the total cohort, skeletal muscle mass index was not predictive of all-cause mortality; however, in the subgroup with diabetes, skeletal muscle mass index did significantly predict all-cause mortality.

In logistic regression analyses, there were significant associations between older age, lower BMI, diabetes, male sex, and sarcopenia. There were also significant associations between major cardiovascular adverse events and higher serum calcium, phosphorus level, history of cardiovascular disease, and cerebrovascular accident.

In conclusion, the researchers said, “In prevalent hemodialysis patients, nutrition, inflammation and previous cardiovascular disease are the major risk factors for all-cause mortality. Skeletal muscle mass index might be an important predictor for all-cause mortality in diabetes patients. In patients with a history of cardiovascular disease or cerebrovascular accident, management of serum calcium and phosphorus is a particularly important aspect of major cardiovascular adverse events.”

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Source: Bae E, Cho J, Na J, et al. Clinical significant of nutritional predictors in prevalent hemodialysis patients. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2019 (Abstract TH-PO601), November 7, 2019, Washington, DC.