title: 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.
abstract: 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.
authors.affiliation: Division of Renal Disease and Hypertension, Loyola University Medical Center, Maywood, IL 60153, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Beto
authors.forename: V K
authors.initials: VK
authors.lastname: Bansal
authors.forename: J
authors.initials: J
authors.lastname: Hart
authors.forename: M
authors.initials: M
authors.lastname: McCarthy
authors.forename: D
authors.initials: D
authors.lastname: Roberts
mesh_terms: 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