PMID- 11792759
OWN - NLM
STAT- MEDLINE
DCOM- 20020306
LR  - 20220408
IS  - 1046-6673 (Print)
IS  - 1046-6673 (Linking)
VI  - 13 Suppl 1
DP  - 2002 Jan
TI  - Inflammation, malnutrition, and cardiac disease as predictors of mortality in 
      hemodialysis patients.
PG  - S28-36
AB  - Various studies suggest a strong association between nutrition and clinical 
      outcome in hemodialysis (HD) patients. Several morbidity factors that per se 
      increase the risk of a poor outcome, such as cardiovascular disease (CVD) and 
      inflammation, may also cause malnutrition. Among laboratory parameters used to 
      assess nutritional status, serum albumin appears to be a particularly strong 
      predictor of morbidity and mortality. This study assessed the importance of 
      nutritional status and inflammation and other comorbidity factors as predictors 
      of mortality in HD patients. Nutritional status was evaluated in 128 HD patients 
      by subjective global nutritional assessment (SGNA) and by measuring several 
      anthropometric markers (actual body weight, percentage of actual body weight to 
      desirable body weight, midarm muscle circumferences, triceps skinfold thickness), 
      and serum albumin, plasma insulin such as insulin growth factor-1 and as a marker 
      of inflammation, serum C-reactive protein (s-CRP) levels. The mortality during 
      the next 36 mo was analyzed in relation to age, gender, CVD, SGNA, serum albumin, 
      CRP, and several other factors by Kaplan-Meier analysis multivariate. Cox 
      proportional hazard analysis was used to identify independent predictors of 
      mortality. After 36 mo, 58 patients were still on HD treatment, 57 patients (45%) 
      had died while receiving treatment, and 13 had received a kidney transplant. The 
      main cause of death was CVD (58%), followed by infection (18%); 
      malnutrition/cachexia was a rare direct cause of death (5%). Kaplan-Meier 
      analysis showed that age, female gender, CVD, diabetes, SGNA, all anthropometric 
      parameters, serum albumin, plasma insulinlike growth factor-1, and s-CRP were 
      significant predictors of mortality. Analysis by the Cox model showed that age, 
      gender, CVD, nutritional status (SGNA), and CRP were independent predictors of 
      mortality at 36 mo. A low albumin level was not an independent predictor, 
      although it was strongly associated with a reduced survival rate in the 
      Kaplan-Meier analysis. Inflammation, malnutrition, and CVD appeared to contribute 
      to increased mortality in a stepwise manner. The mortality at 36 mo was 0% when 
      none of these complications was present, whereas the mortality was 75% in those 
      patients with all three risk factors present at baseline. It is concluded that in 
      addition to malnutrition and comorbidities (CVD, diabetes mellitus), inflammation 
      (elevated s-CRP) is a significant independent risk factor for mortality in HD 
      patients. Inflammation, malnutrition, and CVD appear to be interrelated, each 
      additionally contributing to the high mortality in these patients.
FAU - Qureshi, A Rashid
AU  - Qureshi AR
AD  - Division of Baxter Novum, Department of Clinical Science, Karolinska Institutet, 
      Huddinge University Hospital, Stockholm, Sweden.
FAU - Alvestrand, Anders
AU  - Alvestrand A
FAU - Divino-Filho, Jose C
AU  - Divino-Filho JC
FAU - Gutierrez, Alberto
AU  - Gutierrez A
FAU - Heimburger, Olof
AU  - Heimburger O
FAU - Lindholm, Bengt
AU  - Lindholm B
FAU - Bergstrom, Jonas
AU  - Bergstrom J
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Soc Nephrol
JT  - Journal of the American Society of Nephrology : JASN
JID - 9013836
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiovascular Diseases/*complications
MH  - Cause of Death
MH  - Cross-Sectional Studies
MH  - Female
MH  - Forecasting
MH  - Humans
MH  - Inflammation/*complications
MH  - Male
MH  - Middle Aged
MH  - Nutrition Disorders/*complications
MH  - Proportional Hazards Models
MH  - Renal Dialysis/*mortality
MH  - Renal Insufficiency/*complications/*therapy
MH  - Survival Analysis
EDAT- 2002/01/17 10:00
MHDA- 2002/03/07 10:01
CRDT- 2002/01/17 10:00
PHST- 2002/01/17 10:00 [pubmed]
PHST- 2002/03/07 10:01 [medline]
PHST- 2002/01/17 10:00 [entrez]
PST - ppublish
SO  - J Am Soc Nephrol. 2002 Jan;13 Suppl 1:S28-36.