title: Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS.
abstract: BACKGROUND
  Nutritional status is strongly associated with outcomes among hemodialysis patients. We analyzed the independent predictive value of several readily measured nutritional indicators, including a modified subjective global assessment (mSGA), body mass index (BMI), serum albumin, serum creatinine, normalized protein catabolic rate (nPCR), serum bicarbonate, lymphocyte count, and neutrophil count, using baseline and six-month follow-up measurements.
  
  
  METHODS
  The study sample consisted of 7719 U.S. adult hemodialysis patients enrolled in the international Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective observational study that includes a random sample of hemodialysis patients from 145 dialysis facilities in the United States. Cox regression was used to estimate the relative risk of mortality associated with differences in measurements at baseline and six months later. Each analysis was adjusted for age, race, sex, and 15 summary comorbid conditions.
  
  
  RESULTS
  Lower baseline measurements of mSGA, BMI, serum albumin, serum creatinine, and lymphocyte count were independently associated with significantly higher risk of mortality. During six-month follow-up, decreases in BMI, serum albumin, and serum creatinine were also associated with significantly higher mortality risk. The risk of mortality increased with higher baseline and six-month increases in neutrophil count.
  
  
  CONCLUSIONS
  This study confirms that several readily-measured nutritional indicators predict mortality among hemodialysis patients and that changes in indicator values over six months provide additional important prognostic information. Interventions that modify these indicators of nutritional status may have an important impact on the survival of hemodialysis patients.
authors.affiliation: University Renal Research and Education Association, Department of Medicine, Veterans Affairs Medical Center, and Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA. tpifer@urrea.org
authors.forename: Trinh B
authors.initials: TB
authors.lastname: Pifer
authors.forename: Keith P
authors.initials: KP
authors.lastname: McCullough
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: David A
authors.initials: DA
authors.lastname: Goodkin
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Maroni
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Held
authors.forename: Eric W
authors.initials: EW
authors.lastname: Young
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy* / Q000401:mortality*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000401:mortality; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D012709:Serum Albumin; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D012709:Serum Albumin; D003404:Creatinine