Nutritional parameters and mortality in incident hemodialysis patients

Objective: To evaluate the impact of nutritional parameters at the time of initiation of hemodialysis (HD) on mortality.Design: Retrospective study.Setting: Dialysis Unit of the Federal University of São Paulo, Oswaldo Ramos Foundation.Patients: Three hundred forty-four incident HD patients (60.5% male, 26% diabetic) with the first nutritional evaluation performed before completing 3 months of onset of HD were included.Methods: the study consisted of baseline measurements of several nutritional parameters (triceps skinfold thickness [TSF], midarm muscle circumference [MAMC], body mass index [BMI], serum albumin, serum creatinine, and protein and energy intake assessed by 3-day food diary) and records of outcome (death) over a period of 10 years.Results: Muscle and/or fat depletion was observed in 51% of the studied patients, according to the percent standard of MAMC and TSF, respectively. Presence of diabetes, age over 60 years, serum albumin = 25 (calculated as kg/m(2)) had a negative impact on survival only in the highest tertile (> 2.45 years). Patients with BMI = 25 but MAMC adequacy < 90% had the worst survival (P = .004). in the multivariate survival analysis adjusting for diabetes, advanced age, and hypoalbuminemia, the reduced MAMC (P = .008) and the low energy intake (P = .03) were independent predictors of death in incident HD patients.Conclusions: Reduced MAMC and low energy intake at the beginning of chronic dialysis are risk factors for mortality. A negative effect of high BMI on survival was associated with reduced MAMC and longer dialysis vintage. (c) 2006 by the National Kidney Foundation, Inc.Universidade Federal de São Paulo, Nutr Program, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, Nurse Grp, São Paulo, BrazilUniversidade Federal de São Paulo, Nutr Program, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, Nurse Grp, São Paulo, BrazilWeb of Scienc