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.
Service d'Hépatogastroentérologie et Nutrition, Clinique Résidence du Parc, Marseille, France. njm.cano@wanadoo.fr
Noël J M
NJ
Cano
Hubert
H
Roth
Michel
M
Aparicio
Raymond
R
Azar
Bernard
B
Canaud
Philippe
P
Chauveau
Christian
C
Combe
Denis
D
Fouque
Maurice
M
Laville
Xavier M
XM
Leverve
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