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Title: Nutritional parameters and mortality in incident hemodialysis patients
Authors: Araújo, Isabel Cristina de [UNIFESP]
Kamimura, Maria Ayako [UNIFESP]
Draibe, Sergio Antonio [UNIFESP]
Canziani, Maria Eugênia Fernandes [UNIFESP]
Manfredi, Sílvia Regina [UNIFESP]
Avesani, Carla Maria [UNIFESP]
Sesso, Ricardo de Castro Cintra [UNIFESP]
Cuppari, Lilian [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Issue Date: 1-Jan-2006
Publisher: Elsevier B.V.
Citation: Journal of Renal Nutrition. Philadelphia: W B Saunders Co-Elsevier Inc, v. 16, n. 1, p. 27-35, 2006.
Abstract: Objective: To evaluate the impact of nutritional parameters at the time of initiation of hemodialysis (HD) on mortality.Design: Retrospective study.Setting: Dialysis Unit of the Federal University of São Paulo, Oswaldo Ramos Foundation.Patients: Three hundred forty-four incident HD patients (60.5% male, 26% diabetic) with the first nutritional evaluation performed before completing 3 months of onset of HD were included.Methods: the study consisted of baseline measurements of several nutritional parameters (triceps skinfold thickness [TSF], midarm muscle circumference [MAMC], body mass index [BMI], serum albumin, serum creatinine, and protein and energy intake assessed by 3-day food diary) and records of outcome (death) over a period of 10 years.Results: Muscle and/or fat depletion was observed in 51% of the studied patients, according to the percent standard of MAMC and TSF, respectively. Presence of diabetes, age over 60 years, serum albumin < 3.5 g/dL, MAMC adequacy < 90%, protein intake < 1.0 g/kg/d, and energy intake < 25 kcal/kg/d were associated with worse survival. When patients were analyzed according to tertiles of dialysis vintage, BMI >= 25 (calculated as kg/m(2)) had a negative impact on survival only in the highest tertile (> 2.45 years). Patients with BMI < 25 and MAMC adequacy : 90% showed the best survival over the study period, and those with BMI >= 25 but MAMC adequacy < 90% had the worst survival (P = .004). in the multivariate survival analysis adjusting for diabetes, advanced age, and hypoalbuminemia, the reduced MAMC (P = .008) and the low energy intake (P = .03) were independent predictors of death in incident HD patients.Conclusions: Reduced MAMC and low energy intake at the beginning of chronic dialysis are risk factors for mortality. A negative effect of high BMI on survival was associated with reduced MAMC and longer dialysis vintage. (c) 2006 by the National Kidney Foundation, Inc.
ISSN: 1051-2276
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