2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Qureshi, A. R. Articles by Bergström, J. Search for Related Content PubMed PubMed Citation Articles by Qureshi, A. R. Articles by Bergström, J.

Inflammation, Malnutrition, and Cardiac Disease as Predictors of Mortality in Hemodialysis Patients

Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.

Correspondence to Dr. Bengt Lindholm, Divisions of Baxter Novum and Renal Medicine K-56, Huddinge University Hospital, Karolinska Institutet, S-141 86 Stockholm, Sweden. Phone: +46 8 58582601; Fax: +46 8 6897730; E-mail: bengt.lindholm{at}klinvet.ki.se

Abstract

ABSTRACT. 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.

This article has been cited by other articles:

				S. D. Cohen, P. L. Kimmel, R. Neff, L. Agodoa, and K. C. Abbott Association of Incident Gout and Mortality in Dialysis Patients J. Am. Soc. Nephrol., November 1, 2008; 19(11): 2204 - 2210. [Abstract] [Full Text] [PDF]

				S.-H. Yoo and D.-W. Kang Nutrition and Ischemic Stroke--Reply Arch Neurol, September 1, 2008; 65(9): 1257 - 1258. [Full Text] [PDF]

				D. Cukor, S. D. Cohen, R. A. Peterson, and P. L. Kimmel Psychosocial Aspects of Chronic Disease: ESRD as a Paradigmatic Illness J. Am. Soc. Nephrol., December 1, 2007; 18(12): 3042 - 3055. [Abstract] [Full Text] [PDF]

				J. J. Carrero, A. R. Qureshi, J. Axelsson, C. M. Avesani, M. E Suliman, S. Kato, P. Barany, S. Snaedal-Jonsdottir, A. Alvestrand, O. Heimburger, et al. Comparison of nutritional and inflammatory markers in dialysis patients with reduced appetite Am. J. Clinical Nutrition, March 1, 2007; 85(3): 695 - 701. [Abstract] [Full Text] [PDF]

				M. Suliman, P. Stenvinkel, A. R. Qureshi, K. Kalantar-Zadeh, P. Barany, O. Heimburger, E. F. Vonesh, and B. Lindholm The reverse epidemiology of plasma total homocysteine as a mortality risk factor is related to the impact of wasting and inflammation Nephrol. Dial. Transplant., January 1, 2007; 22(1): 209 - 217. [Abstract] [Full Text] [PDF]

				S. Utaka, C. M Avesani, S. A Draibe, M. A Kamimura, S. Andreoni, and L. Cuppari Inflammation is associated with increased energy expenditure in patients with chronic kidney disease Am. J. Clinical Nutrition, October 1, 2005; 82(4): 801 - 805. [Abstract] [Full Text] [PDF]

				M. E Suliman, A R. Qureshi, P. Stenvinkel, R. Pecoits-Filho, P. Barany, O. Heimburger, B. Anderstam, E. Rodriguez Ayala, J. C Divino Filho, A. Alvestrand, et al. Inflammation contributes to low plasma amino acid concentrations in patients with chronic kidney disease Am. J. Clinical Nutrition, August 1, 2005; 82(2): 342 - 349. [Abstract] [Full Text] [PDF]

				R. Schiel, S. Heinrich, T. Steiner, U. Ott, and G. Stein Long-term prognosis of patients after kidney transplantation: a comparison of those with or without diabetes mellitus Nephrol. Dial. Transplant., March 1, 2005; 20(3): 611 - 617. [Abstract] [Full Text] [PDF]

				B. Bammens, P. Evenepoel, K. Verbeke, and Y. Vanrenterghem Impairment of small intestinal protein assimilation in patients with end-stage renal disease: extending the malnutrition-inflammation-atherosclerosis concept Am. J. Clinical Nutrition, December 1, 2004; 80(6): 1536 - 1543. [Abstract] [Full Text] [PDF]

				A. Yee-Moon Wang, M. Man-Mei Sea, N. Tang, J. E. Sanderson, S.-F. Lui, P. Kam-Tao Li, and J. Woo Resting Energy Expenditure and Subsequent Mortality Risk in Peritoneal Dialysis Patients J. Am. Soc. Nephrol., December 1, 2004; 15(12): 3134 - 3143. [Abstract] [Full Text] [PDF]

				S. Beddhu, L. M. Pappas, N. Ramkumar, and M. H. Samore Malnutrition and Atherosclerosis in Dialysis Patients J. Am. Soc. Nephrol., March 1, 2004; 15(3): 733 - 742. [Abstract] [Full Text] [PDF]

				B. Hocher, R. Ziebig, C. Altermann, R. Krause, G. Asmus, C.-M. Richter, T. Slowinski, P. Sinha, and H.-H. Neumayer Different Impact of Biomarkers as Mortality Predictors among Diabetic and Nondiabetic Patients Undergoing Hemodialysis J. Am. Soc. Nephrol., September 1, 2003; 14(9): 2329 - 2337. [Abstract] [Full Text] [PDF]

				J. S. Zebrack, J. L. Anderson, S. Beddhu, B. D. Horne, T. L. Bair, A. Cheung, J. B. Muhlestein, and Intermountain Heart Collaborative Study Group Do associations with C-Reactive protein and extent of coronary artery disease account for the increased cardiovascular risk of renal insufficiency? J. Am. Coll. Cardiol., July 2, 2003; 42(1): 57 - 63. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673