Hemodialysis prognostic nutrition index as a predictor for morbidity and mortality in hemodialysis patients and its correlation to adequacy of dialysis. Council on Renal Nutrition National Research Question Collaborative Study Group.
OBJECTIVE
Prospectively examine the use of a hemodialysis prognostic nutrition index (HD-PNI) as a predictor for morbidity and mortality in hemodialysis patients and its correlation to adequacy of dialysis.


METHODS
Prospective randomized collaborative study group.


METHODS
There were 211 chronic hemodialysis centers; 202 from 43 United States, 9 from Canada.


METHODS
There were 1527 hemodialysis patients undergoing treatment a minimum of 3 months and at least 18 years of age. Sample mirrored United States Renal Data System data for age, sex, race, and etiology of renal failure.


METHODS
None; routinely collected demographic, biochemical, and clinical data for 8-month baseline and 3-month predictive phases.


METHODS
HD-PNI calculated from baseline data as linear mathematical equation using level of serum albumin, level of serum creatinine, and number of days and times hospitalized; HD-PNI risk defined as >/=0.8. Adequacy of dialysis calculated as urea reduction ratio (URR) from baseline data; adequacy risk defined as URR of </=65%.


METHODS
Number of times and days hospitalized, mortality.


RESULTS
For this research, 1167 patients completed the study (76%) with 360 (24%) dropped due to death, incomplete data, transfer, or change in modality. Patients completing study with HD-PNI risk (n = 208, 18%) compared with patients who had no HD-PNI risk (n = 959, 82%) were hospitalized more often (57.2% v 28.5%, P <. 01), hospitalized with infection more often (14.6% v 4.6%, P <.01), and had greater mortality (7.7% v 2.5%, P <.01). Stratification of HD-PNI risk by URR of >/=65% did not significantly improve prediction.


CONCLUSIONS
Use of HD-PNI is an effective screening tool to identify hemodialysis patients at risk for morbidity and mortality. No correlation was found between URR and HD-PNI.
Beto
J A
JA
Division of Renal Disease and Hypertension, Loyola University Medical Center, Maywood, IL 60153, USA.
Bansal
V K
VK
Hart
J
J
McCarthy
M
M
Roberts
D
D
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors