Improvement in nutritional parameters after initiation of chronic hemodialysis.
BACKGROUND
Protein-calorie malnutrition is highly prevalent in patients with chronic renal failure and on chronic dialysis therapy. Longitudinal studies evaluating nutritional outcomes after the initiation of chronic dialysis therapy in incident dialysis patients are limited.


METHODS
This prospective cohort study evaluated time-dependent changes in several well-defined markers of nutritional status before and after initiation of chronic hemodialysis therapy. Fifty incident hemodialysis (HD) patients (60% men, 38% white, 32% with insulin-dependent diabetes mellitus) were studied. Multiple nutritional markers, including biochemical parameters and analysis of body composition, were assessed before the initial outpatient CHD treatment and every 3 months thereafter for 12 months.


RESULTS
At baseline, nutritional markers correlated well with each other. After the initiation of HD therapy, there were marked improvements in most nutritional parameters, including serum albumin, serum prealbumin, normalized protein catabolic rate, fat mass, reactance, and phase angle (P < 0.05 for all). Improvements in nutritional parameters were influenced by baseline nutritional status; ie, baseline nutritional parameters were predictors of their end-of-study value.


CONCLUSIONS
Initiation of CHD therapy is associated with improvements in most nutritional markers. Nutritional benefits of increased solute clearance provided by the initiation of chronic dialysis therapy prevail over its potential catabolic effects. However, the extent of improvement was dependent on nutritional status at the time of initiation of dialysis therapy, which remained an important determinant of subsequent nutritional improvements during the first year of treatment.
Pupim
Lara B
LB
Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN 37232-2372, USA.
Kent
Pamela
P
Caglar
Kayser
K
Shyr
Yu
Y
Hakim
Raymond M
RM
Ikizler
T Alp
TA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications; D003928:Diabetic Nephropathies / Q000097:blood / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000209:etiology / Q000628:therapy; D011506:Proteins / Q000378:metabolism; D006435:Renal Dialysis / Q000379:methods; D012737:Sex Factors
D015415:Biomarkers; D011506:Proteins