title: Kt/V, nutritional parameters, serum cortisol, and insulin growth factor-1 levels and patient outcome in hemodialysis.
abstract: Despite many technical advances in dialysis care, morbidity and mortality in chronic hemodialysis patients in the United States remains high. In this study, we analyzed the effects of Kt/V, nutritional parameters (serum albumin level, triceps skin-fold thickness, mid-arm muscle circumference, and normalized protein catabolic rate), and predialysis serum cortisol and insulin growth factor-1 levels on predicting morbidity and mortality. The cohort studied consisted of 52 patients recruited from a single outpatient dialysis facility. Cox proportional hazards modeling indicated that only Kt/V predicted subsequent mortality (P = 0.02), while both predialysis cortisol levels (P = 0.03) and Kt/V (P = 0.03) predicted hospitalization. Kaplan-Meier analysis demonstrated that the ability of cortisol levels to predict hospitalization was largely confined to the group with values greater than 22 micrograms/dL predialysis. High serum cortisol levels were correlated with low serum albumin levels and a trend toward low triceps skin-fold thickness and higher normalized protein catabolic rate, suggesting a catabolic state. Both predialysis serum cortisol and insulin growth factor-1 levels were higher than those in age- and sex-matched normal human controls. These results demonstrate the importance role of Kt/V in predicting subsequent hospitalization rates and mortality, and that high predialysis serum cortisol levels correlate with a high hospitalization rate.
authors.affiliation: Division of Nephrology, Maine Medical Center, Portland 04102.
authors.forename: J
authors.initials: J
authors.lastname: Himmelfarb
authors.forename: D
authors.initials: D
authors.lastname: Holbrook
authors.forename: E
authors.initials: E
authors.lastname: McMonagle
authors.forename: R
authors.initials: R
authors.lastname: Robinson
authors.forename: L
authors.initials: L
authors.lastname: Nye
authors.forename: D
authors.initials: D
authors.lastname: Spratt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D009752:Nutritional Status; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis; D012885:Skinfold Thickness; D016896:Treatment Outcome; D014508:Urea / Q000097:blood*
chemical_list: D012709:Serum Albumin; D007334:Insulin-Like Growth Factor I; D014508:Urea; D006854:Hydrocortisone