Association between nutritional indicators and risk of hospitalization among hemodialysis patients
Keywords:
Albumins, Hospitalization, Malnutrition, Nutritional assessment, Renal dialysisAbstract
Objective
To verify the ability of nutritional indicators to predict risk of hospitalization in hemodialysis patients.
Methods
This prospective cohort study was conducted in two hemodialysis units in Southern Brazil. The following nutritional indicators were evaluated: subjective global assessment, malnutrition-inflammation score, nutritional risk screening 2002, percentage of body fat, mid-upper arm muscle circumference, hand grip strength, phase angle, and serum albumin. The association between nutritional indicators and risk of hospitalization over a period of two years was analyzed.
Results
One hundred thirty-eight patients (55.4±15.2 years, 61.6% men) were evaluated. The cumulative incidence of hospitalization during the study was 48.0% (95%CI=37.9-58.0). Patients hospitalized during the study period had higher body mass index and lower serum albumin than those who were not hospitalized. Based on the other indicators, malnourished patients did not have a significant risk of hospitalization (p>0.05). Serum albuminwas the only predictor of hospitalization. Patients with levels <3.8 g/dL had a density ratio for incidence of hospitalization 2.47 times greater than those with higher levels (p=0.003). Gender was a modifier of the effect
(p interaction=0.042), with an effect in women of 7.31 (95%CI=2.34-22.9; p=0.001) and in men of 1.37
(95%CI=0.60-3.12; p=0.448).
Conclusion
Serum albumin was able to predict the risk of hospitalization over a period of two years in female patients undergoing hemodialysis.
References
Grassmann A, Gioberge S, Moeller S, Brown G. ESRD patients in 2004: Global overview of patient numbers, treatment modalities and associated trends. Nephrol Dial Transplant. 2005; 20:2587-93. http://dx.doi.org/10.1093/ndt/gfi159
Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A proposed nomenclature and diagnostic criteria for protein energy wasting in acute and chronic kidney disease. Kidney Int. 2008; 73(4):391-8. http://dx.doi.org/ 10.1038/sj.ki.5002585
Acuña K, Cruz T. Avaliação do estado nutricional de adultos e idosos e situação nutricional da popu lação brasileira. Arq Bras Endocrinol Metab. 2004; 48(3):345-61.
Ikizler TA. Optimal nutrition in hemodialysis patients. Adv Chronic Kidney Dis. 2013; 20(2):181-9. http://dx.doi.org/10.1053/j.ackd.2012.12.002
Lim SL, Ong KCB, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012; 31(3):345-50. http://dx.doi.org/10.1016/j.clnu.2011.11.001
Ikizler TA, Wingard RL, Harvell J, Shyr Y, Hakim RM. Association of morbidity with markers of nutrition and inflammation in chronic hemodialysis patients: A prospective study. Kidney Int. 1999; 55(5):1945-51. http://dx.doi.org/10.1046/j.1523-1755.1999.00 410.x
Daratha KB, Short RA, Corbett CF, Ring ME, Alicic R, Choka R, et al. Risks of subsequent hospitalization and death in patients with kidney disease. Clin J Am Soc Nephrol. 2012; 7(3):409- 16. http://dx.doi.org/10.2215/CJN.05070511
Laws RA, Tapsell LC, Kelly J. Nutritional status and its relationship to quality of life in a sample of chronic hemodialysis patients. J Ren Nutr. 2000; 10(3):139-47. http://dx.doi.org/10.1053/jren.2000. 7412
Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol. 2001; 12(12):2797-806.
Chiang CK, Hsu SP, Pai MF, Peng YS, Ho TI, Liu SH, et al. Interleukin-18 is a strong predictor of hospitalization in haemodialysis patients. Nephrol Dial Transplant. 2004; 19(11):2810-15. http://dx. doi.org/10.1093/ndt/gfh475
Kalantar-Zadeh K, Block G, McAllister CJ, Humphreys MH, Kopple JD. Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr. 2004; 80(2):299-307.
Pisetkul C, Chanchairujira K, Chotipanvittayakul N, Ong-Ajyooth L, Chanchairujira T. Malnutrition inflammation score associated with atherosclerosis, inflammation and short-term outcome in hemodialysis patients. J Med Assoc Thai. 2010; 93(1):147-56.
Habicht J. Estandarización de métodos epidemioló gicos cuantitativos sobre el terreno. Bol Oficina Sanit Panam. 1974; 76(5):375-84.
World Health Organization. Physical status: The use and interpretation of anthropometry. Geneva: WHO; 1995.
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr. 1987; 11(1):8-13. http:// dx.doi.org/10.1177/014860718701100108
Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2001; 38(6):1251-63. http://dx.doi.org/10.1053/ajkd. 2001.29222
Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin Nutr. 2003; 22(3):321-36. http://dx.doi.org/10.1016/S0261-5 614(02)00214-5
Garcia MF, Wazlawik E, Moreno YMF, Führ LM, González-Chica DA. Diagnostic accuracy of handgrip strength in the assessment of malnutrition in hemodialyzed patients. e-SPEN J. 2013; 8(4):181-6. http://dx.doi.org/10.1016/j.clnme.2013.06.003
Barbosa-Silva MC. Subjective and objective nutritional assessment methods: What do they really assess? Curr Opin Clin Nutr Metab Care. 2008; 11(3):248-54. http://dx.doi.org/10.1097/MCO. 0b013e3282fba5d7
Kopple JD, Greene T, Chumlea WC, Hollinger D, Maroni BJ, Berril D, et al. Relationship between nutritional status and the glomerular filtration rate: Results from the MDRD Study. Kidney Int. 2000; 57(4):1688-703. http://dx.doi.org/10.1046/ j.1523-1755.2000.00014.x 21. Cuppari L, Kamimura MA. Avaliação nutricional na doença renal crônica: desafios na prática clínica. J Bras Nefrol. 2009; 31(1):28-35.
Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis. J Am Soc Nephrol. 2004; 15(8):2208-18. http:// dx.doi.org/10.1097/01.ASN.0000133041.27682. A2
Arkouche W, Traeger J, Delawari E, Sibaï-Galland R, Abdullah E, Galland R, et al. Twenty-five years of experience with out-center hemodialysis. Kidney Int. 1999; 56(6):2269-75. http://dx.doi.org/10. 1046/j.1523-1755.1999.00771.x
Lacson EJ, Ikizler TA, Lazarus JM, Teng M, Hakim RM. Potential impact of nutritional intervention on end-stage renal disease hospitalization, death, and treatment costs. J Ren Nutr. 2007; 17(6):363-71. http://dx.doi.org/10.1053/j.jrn.2007.08.009
Fiedler R, Jehle PM, Osten B, Dorligschaw O, Girnd M. Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance. Nephrol Dial Transplant. 2009; 24(12):3812-7. http://dx.doi. org/10.1093/ndt/gfp346
Marcén R, Teruel JL, de la Cal MA, Gámez C. The impact of malnutrition in morbidity and mortality in stable haemodialysis patients. Spanish Cooperative Study of Nutrition in Hemodialysis. Nephrol Dial Transplant. 1997; 12(11):2324-31. http://dx.doi. org/10.1093/ndt/12.11.2324
Santos NSJ, Draibe SA, Kamimura MA, Canziani ME, Cendorogolo M, Garcia Júnior A, et al. Is serum albumin a marker of nutritional status in hemodialysis patients without evidence of inflammation? Artif Organs. 2003; 27(8):681-6. http://dx.doi.org/10.10 46/j.1525-1594.2003.07273.x
Kaysen GA, Dubin JA, Müller HG, Mitch WE, Rosales LM, Levin NW. Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients. Kidney Int. 2002; 61(6):2240-9. http://dx.doi.org/ 10.1046/j.1523-1755.2002.00076.x
Don BR, Kaysen GA. Assessment of inflammation and nutrition in patients with end-stage renal disease. J Nephrol. 2000; 13(4):249-59.
Mutsert R, Grootendorst DC, Indemans F, Boeschoten EW, Krediet RT, Dekker FW, et al. Association between serum albumin and mortality in dialysis patients is partly explained by inflammation, and not by malnutrition. J Ren Nutr. 2009; 19(2):127-35. http://dx.doi.org/10.1053/j. jrn.2008.08.003
Vincent J, Dubois M, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: Is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003; 237(3):319-34. http://dx.doi.org/10.1097/01.SLA.0 000055547.93484.87
Leon JB, Majerle AD, Soinski JA, Kushner I, Ohri Vachaspati P, Sehgal AR. Can a nutrition intervention improve albumin levels among hemodialysis patients? A pilot study. J Ren Nutr. 2001; 11(1):9-15. http://dx.doi.org/10.1016/S1051-2276(01)79890-1
Leon JB, Albert JM, Gilchrist G, Kushner I, Lerner E, Mach S, et al. Improving albumin levels among hemodialysis patients: A community-based randomized controlled trial. Am J Kidney Dis. 2006; 48(1):28-36. http://dx.doi.org/10.1053/j.ajkd.2006. 03.046
Schlüssel MM, Anjos LA, Kac G. A dinamometria manual e seu uso na avaliação nutricional. Rev Nutr. 2008; 21(2):223-35. http://dx.doi.org/10.1590/ S1415-52732008000200009
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