Uremic malnutrition is a predictor of death independent of inflammatory status

• Published in: Kidney international Vol. 66; no. 5; pp. 2054 - 2060
• Main Authors: Pupim, Lara B., Caglar, Kayser, Hakim, Raymond M., Shyr, Yu, Ikizler, T. Alp
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-2004; Nature Publishing; Elsevier Limited
• Subjects: Adult; Biological and medical sciences; Biomarkers - blood; C-reactive protein; Cardiovascular Diseases - mortality; Chronic Disease; Cohort Studies; Female; Humans; inflammation; Inflammation - complications; Male; Malnutrition - etiology; Medical sciences; Metabolic diseases; Middle Aged; mortality; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; nutrition; Nutritional Status; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); phase angle; Predictive Value of Tests; Prospective Studies; Renal Dialysis - mortality; Renal failure; serum albumin; serum prealbumin; Time Factors; Uremia - complications; nutrition; C-reactive protein; inflammation; serum prealbumin; mortality; phase angle; serum albumin; Kidney disease; Nephrology; Urinary system disease; Nutrition; Predictor; Mortality; Nutrition disorder; Prediction; Inflammation; Serum albumin; Epidemiology; Urology; Feeding; Acute phase protein; Angle; Renal failure; Death; Serum; Predictive factor; Malnutrition; C reactive protein
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1111/j.1523-1755.2004.00978.x

Uremic malnutrition is a predictor of death independent of inflammatory status.
Several studies have pointed out the influence of nutritional parameters and/or indices of inflammation on morbidity and mortality. Often, these conditions coexist, and the relative importance of poor nutritional status and chronic inflammation in terms of predicting clinical outcomes in chronic hemodialysis (CHD) patients has not been clarified.
We undertook a prospective cohort study analyzing time-dependent changes in several established nutritional and inflammatory markers, and their influence on mortality in 194 CHD patients (53% male, 36% white, 30% with diabetes mellitus, mean age 55.7 ± 15.4 years) throughout a 57-month period. Serial measurements of serum concentrations of albumin, prealbumin, creatinine, transferrin, cholesterol, and C-reactive protein (CRP), as well as normalized protein catabolic rate, postdialysis weight, and phase angle and reactance by bioelectrical impedance analysis were performed every 3 months. Clinical outcomes were simultaneously assessed using indicators of mortality.
Serum albumin, serum prealbumin, serum creatinine, and phase angle were significant predictors of all-cause mortality, even after adjustment for serum CRP concentrations. Serum CRP concentrations were not significantly associated with mortality. Serum albumin concentrations and phase angle were also independent predictors of cardiovascular deaths in the multivariate model.
The nutritional status of CHD patients predicts mortality independent of concomitant presence or absence of inflammatory response. Prevention of, and timely intervention to treat uremic malnutrition by suitable means are necessary independent of the presence and/or therapy of inflammation in terms of improving clinical outcomes in CHD patients.