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Kidney Int. 2005 Oct;68(4):1766-76.

Are nutritional status indicators associated with mortality in the Hemodialysis (HEMO) Study?

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  • 1Tufts University School of Medicine and Friedman School of Nutrition Science and Policy, Boston, Massachusetts 02111, USA. JDwyer1@tufts-nemc.org

Abstract

BACKGROUND:

The purpose of this study was to determine if indicators of nutritional status were associated with subsequent mortality in hemodialysis patients.

METHODS:

Twelve selected nutrition indicators were measured prior to randomization in the Mortality and Morbidity in Hemodialysis (HEMO) Study. Relative risks (RR) of mortality were assessed at <6 months and >6 months of follow-up using Cox regression after controlling for case mix, comorbidity, and treatment assignment (high vs. standard Kt/V and high vs. low membrane flux).

RESULTS:

Low values of most nutritional status indicators were associated with increased RR of mortality. RRs were greatest over the short term (<6 months) and diminished with increasing follow-up (>6 months). Increases in body mass index (BMI) at lower levels (e.g., < or =25 kg/m(2)) and increases in serum albumin at any level were associated with reduced short-term RR, even after adjusting for case mix, treatment assignment, and for the joint effects of equilibrated normalized protein catabolic rate, total cholesterol, and serum creatinine. For >6 months' follow-up, increases in values among those with lower levels of BMI and serum albumin (< or =3.635 g/dL) and increases in all serum creatinine levels were associated with lower RR.

CONCLUSION:

Nutrition indicators are associated with subsequent mortality in a time-dependent manner, with greatest effects at <6 months of follow-up. The RR for these indicators may also vary within different ranges of values.

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