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Experts Link Poor Nutrition in Dialysis with Early Death

FASCINATING NEW RESEARCH has found that patients with a poor nutritional status when beginning have an increased risk of death. The study, led by Sara Blumberg Benyamini, Wolfson Medical Center, Holon, Israel, measured Integrative Clinical Nutrition Dialysis Scores (ICNDS) over a period of 3 months in 297 patients receiving dialysis, and ranked seven parameters from 1–5, reflecting ‘abnormal’ to ‘meets guideline recommendations’, respectively.

Scientists measured patients’ ICNDS at dialysis initiation and at 1, 2, and 3 months after initiation. Parameters included: serum albumin, creatinine, urea, cholesterol, dialysis adequacy, C-reactive protein, and post-dialysis weight change. An ICNDS of <75 was considered low, while a score of >75 was considered high. Patients with a low score had a 2.5- and 1.5-fold increased risk of all-cause death at 1 and 5 years, respectively, compared with high-scoring patients. Those who experienced a deterioration in nutritional status in the first 3 months of dialysis were found to have a 1.7-fold increased risk of mortality within 3 years, regardless of nutritional status at initiation.

Benyamini and colleagues found that patients who had a low ICNDS when dialysis began were markedly older and were associated with a higher incidence of diabetes and cardiovascular disease, as well as increased C-reactive protein levels. Experts linked the significant differences in mortality risk to malnutrition-inflammation complex syndrome in patients, which involves protein-energy wasting and inflammation. Benyamini and her team advised: “We suggest a multidisciplinary approach that includes attention to diet and provision of adequate treatment for comorbidities in the period before initiation of dialysis, with the aim of increasing the ICNDS during the transition to [renal replacement therapy]. This then might improve survival odds after dialysis initiation.”