Nutritional predictors of mortality in prevalent peritoneal dialysis patients
Languages of publication
Malnutrition remains one of the major predictors of mortality in peritoneal dialysis (PD) patients. The aim of the study was to evaluate the nutritional status of prevalent PD patients, and to determine the best predictors of outcome among anthropometric and laboratory indices of nutrition. The study included 106 prevalent PD patients from a single university-based unit. Anthropometric assessment at baseline included: body mass, body mass index (BMI), skinfold thickness, lean body mass (LBM), content of body fat (%F), mid-arm muscle circumference (MAMC). Laboratory analysis comprised of albumin and total cholesterol. Additionally, each patient underwent a subjective global assessment (SGA). The patients were followed for 36 months. Survival analyses were made with the Kaplan-Meier survival curve and the Cox proportional hazard model. Following SGA, malnutrition was diagnosed in 30 (28%) patients. Importantly, eight of the malnourished patients (27%) were nevertheless overweight or obese. Body weight and BMI showed complete lack of association with the outcome. In Kaplan-Meier analysis low: LBM, MAMC, albumin and cholesterol were significantly related to mortality. Cox analysis revealed that, following adjustment, LBM below median was independently associated with poor outcome (hazard ratio [HR] 3.15, 95% confidence interval [CI] 1.17-8.49, p=0.02). Moreover, the lowest quartile of total cholesterol showed independent association with mortality (HR 8.68, CI 2.14-35.21, p<0.01). Malnutrition is prevalent in patients undergoing PD, and overweight/obesity does not preclude its appearance. The most valuable nutritional indices in predicting outcome in this cohort were LBM and total cholesterol concentration.
- Bergstrom J (1995) Nutrition and mortality in hemodialysis. J Am Soc Nephrol 6: 1329-1341.
- Burrowes JD, Dalton S, Backstrand J, Levin NW (2005) Patients receiving maintenance hemodialysis with low vs high levels of nutritional risk have decreased morbidity. J Am Diet Assoc 105: 563-572.
- Carrero JJ, Chmielewski M, Axelsson J, Snaedal S, Heimburger O, Barany P, Suliman ME, Lindholm B, Stenvinkel P, Qureshi AR (2008) Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients. Clin Nutr 27: 557-564.
- Chmielewski M, Carrero JJ, Qureshi AR, Axelsson J, Heimburger O, Berglund L, Barany P, Rutkowski B, Lindholm B, Stenvinkel P (2009) Temporal discrepancies in the association between the apoB/apoA-I ratio and mortality in incident dialysis patients. J Intern Med 265: 708-716.
- Chmielewski M, Verduijn M, Drechsler C, Lindholm B, Stenvinkel P, Rutkowski B, Boeschoten EW, Krediet RT, Dekker FW (2011) Low cholesterol in dialysis patients - causal factor for mortality or an effect of confounding? Nephrol Dial Transplant 26: 3325-3331.
- Chung SH, Lindholm B, Lee HB (2000) Influence of initial nutritional status on continuous ambulatory peritoneal dialysis patient survival. Perit Dial Int 20: 19-26.
- Chung SH, Lindholm B, Lee HB (2003) Is malnutrition an independent predictor of mortality in peritoneal dialysis patients? Nephrol Dial Transplant 18: 2134-2140.
- Churchill D, Taylor W, Keshoniah P (1996) Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 7: 198-207.
- Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Trevino-Becerra A, Wanner C (2008) A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 73: 391-398.
- Habib AN, Baird BC, Leypoldt JK, Cheung AK, Goldfarb-Rumyantzev AS (2006) The association of lipid levels with mortality in patients on chronic peritoneal dialysis. Nephrol Dial Transplant 21: 2881-2892.
- Haffner SM (2007) Abdominal adiposity and cardiometabolic risk: do we have all the answers? Am J Med 120: S10-S16.
- Huang JW, Lien YC, Wu HY, Yen CJ, Pan CC, Hung TW, Su CT, Chiang CK, Cheng HT, Hung KY (2013) Lean body mass predicts long-term survival in Chinese patients on peritoneal dialysis. PLoS One 8: e54976.
- Kilpatrick RD, McAllister CJ, Kovesdy CP, Derose SF, Kopple JD, Kalantar-Zadeh K (2007) Association between serum lipids and survival in hemodialysis patients and impact of race. J Am Soc Nephrol 18: 293-303.
- Liu Y, Coresh J, Eustace JA, Longenecker JC, Jaar B, Fink NE, Tracy RP, Powe NR, Klag MJ (2004) Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition. JAMA 291: 451-459.
- Lowrie EG, Lew NL (1990) Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 15: 458-482.
- Malgorzewicz S, Lichodziejewska-Niemierko M, Aleksandrowicz-Wrona E, Swietlik D, Rutkowski B, Lysiak-Szydlowska W (2010) Adipokines, endothelial dysfunction and nutritional status in peritoneal dialysis patients. Scand J Urol Nephrol 44: 445-451.
- Malgorzewicz S, Lichodziejewska-Niemierko M, Rutkowski B, Lysiak-Szydlowska W (2004) Nutritional status and oxidative processes in diabetic and nondiabetic peritoneal dialysis patients. J Ren Nutr 14: 242-247.
- McDonald SP, Collins JF, Johnson DW (2003) Obesity is associated with worse peritoneal dialysis outcomes in the Australia and New Zealand patient populations. J Am Soc Nephrol 14: 2894-2901.
- NCEP - Third Report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) Final Report. (2002) Circulation 106: 3143-3421.
- Noori N, Kovesdy CP, Dukkipati R, Kim Y, Duong U, Bross R, Oreopoulos A, Luna A, Benner D, Kopple JD, Kalantar-Zadeh K (2010) Survival predictability of lean and fat mass in men and women undergoing maintenance hemodialysis. Am J Clin Nutr 92: 1060-1070.
- Park J, Ahmadi SF, Streja E, Molnar MZ, Flegal KM, Gillen D, Kovesdy CP, Kalantar-Zadeh K (2014) Obesity paradox in end-stage kidney disease patients. Prog Cardiovasc Dis 56: 415-425.
- Rauchhaus M, Coats AJ, Anker SD (2000) The endotoxin-lipoprotein hypothesis. Lancet 356: 930-933.
- Snyder JJ, Foley RN, Gilbertson DT, Vonesh EF, Collins AJ (2003) Body size and outcomes on peritoneal dialysis in the United States. Kidney Int 64: 1838-1844.
- Stenvinkel P, Heimburger O, Lindholm B, Kaysen GA, Bergstrom J (2000) Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 15: 953-960.
- Tennankore KK, Bargman JM (2013) Nutrition and the kidney: recommendations for peritoneal dialysis. Adv Chronic Kidney Dis 20: 190-201.
- Trivedi H, Tan SH, Prowant B, Sherman A, Voinescu CG, Atalla J, Khanna R, Nolph K (2005) Predictors of death in patients on peritoneal dialysis: the Missouri Peritoneal Dialysis Study. Am J Nephrol 25: 466-473.
- Visser R, Dekker FW, Boeschoten EW, Stevens P, Krediet RT (1999) Reliability of the 7-point subjective global assessment scale in assessing nutritional status of dialysis patients. Adv Perit Dial 15: 222-225.
Publication order reference