Malnutrition in hemodialysis diabetic patients: evaluation and prognostic influence.
BACKGROUND
This work aimed to evaluate the role of malnutrition in the increased mortality rate of hemodialysis diabetic patients from a French cooperative series.


METHODS
Body mass index (BMI), serum albumin, prealbumin, cholesterol, and pre-dialysis creatinine, normalized protein catabolic rate and lean body mass (LBM) were measured in 734 diabetic and 6389 non-diabetic patients (aged 63.4 +/- 12.2 and 62.0 +/- 15.9 years; 1.01 male to 1.40 female ratio). The outcome of 1610 of these patients, including 170 diabetics, was assessed during a 30-month follow-up.


RESULTS
Diabetic as compared to non-diabetic patients showed a significant (P < 10-4) increased BMI (25.9 +/- 5.2 vs. 23.1 +/- 4.3) and cholesterol (5.5 +/- 1.6 vs. 5.3 +/- 1.5 mmol/L), and decreased albumin (37.8 +/- 5.4 vs. 38.9 +/- 5.3 g/L), prealbumin (317 +/- 91 vs. 340 +/- 94 mg/L), creatinine (711 +/- 184 vs. 816 +/- 217 micromol/L) and LBM (76 +/- 18 vs. 87 +/- 21%). Normalized protein catabolic rate was similar in the two groups (1.11 +/- 0.31 vs. 1.13 +/- 0.32 g/kg/L). One and two-year survival was 83.7 +/- 2.9% and 65.5 +/- 3.8% in diabetic patients versus 90.3 +/- 0.8% and 79.9 +/- 1.1% in non-diabetics (relative risk 1.26, P < 0.01). Independent predictors of survival were age, albumin and prealbumin in non-diabetics and only age in diabetics.


CONCLUSIONS
Diabetic patients compared to non-diabetics were characterized by an increased incidence of protein malnutrition and decreased survival. However, the higher death risk associated with diabetes was not related to malnutrition.
Cano
Noël J M
NJ
Service d'Hépatogastroentérologie et Nutrition, Clinique Résidence du Parc, Marseille, France. njm.cano@wanadoo.fr
Roth
Hubert
H
Aparicio
Michel
M
Azar
Raymond
R
Canaud
Bernard
B
Chauveau
Philippe
P
Combe
Christian
C
Fouque
Denis
D
Laville
Maurice
M
Leverve
Xavier M
XM
D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011379:Prognosis; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000401:mortality*; D006435:Renal Dialysis; D016019:Survival Analysis