Improvement in Nutritional Parameters After Initiation of Chronic Hemodialysis

• Published in: Nutrition in clinical practice Vol. 17; no. 6; p. 382
• Main Authors: Pupim, LB, Kent, P, Caglar, K
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-12-2002; Sage Publications
• ISSN: 0884-5336; 1941-2452
• DOI: 10.1177/0115426502017006382

Protein-calorie malnutrition is highly preventable in patients with chronic
renal failure and on chronic dialysis therapy. Longitudinal studies evaluating
nutritional outcomes after the initiation of chronic dialysis therapy in
incident dialysis patients are limited. Methods: This prospective
cohort study evaluated time-dependent changes in several well-defined markers
of nutritional status before and after initiation of chronic hemodialysis
therapy. Fifty incident hemodialysis (HD) patients (60% men, 38% white, 32%
with insulin-dependent diabetes mellitus) were studied. Multiple nutritional
markers, including biochemical parameters and analysis of body composition,
were assessed before the initial outpatient chronic HD treatment and every 3
months thereafter for 12 months. Results: At baseline, nutritional
markers correlated well with each other. After the initiation of HD therapy,
there were marked improvements in most nutritional parameters, including serum
albumin, serum prealbumin, normalized protein catabolic rate, fat mass,
reactance, and phase angle (P < 0.05 for all). Improvements in nutritional
parameters were influenced by baseline nutritional status, ie, baseline
nutritional parameters were predictors of their end-of-study value.
Conclusion: Initiation of chronic HD therapy is associated with
improvements in most nutritional markers. Nutritional benefits of increased
solute clearance provided by the initiation of chronic dialysis therapy
prevail over its potential catabolic effects. However, the extent of
improvement was dependent on nutritional status at the time of initiation of
dialysis therapy, which remained an important determinant of subsequent
nutritional improvements during the first year of treatment.