title: Nutritional state correlates with renal function at the start of dialysis.
abstract: OBJECTIVE
  To determine the effect of renal function at the commencement of dialysis on nutritional state.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University tertiary referral hospital.
  
  
  METHODS
  Patients with end-stage renal disease commencing renal replacement therapy over 8.5 years.
  
  
  METHODS
  Total body nitrogen assessment using in vivo neutron activation analysis, expressed as nitrogen index (NI = observed total body nitrogen/predicted total body nitrogen); serum albumin measurement and creatinine clearance estimation, using the Cockcroft-Gault equation, at the start of dialysis. "Early" start group = creatinine clearance > 10 mL/minute (n = 26). "Late" start group = creatinine clearance < or = 10 mL/min (n = 108).
  
  
  RESULTS
  Mean NI was significantly lower [95% confidence interval (CI) 6%-30%, p < 0.0001] in the late start group (NI = 88%) compared to the early start group (NI = 106%). The late start group also had a significantly lower (95% CI 0.06-0.47 g/dL, p = 0.02) mean serum albumin level (3.66 g/dL) compared to that of the early start group (3.93 g/dL). A positive independent correlation existed between renal function and total body nitrogen (r2 = 0.21, p < 0.0001). No other clinical or demographic variable at the start of dialysis was found to predict nutritional state.
  
  
  CONCLUSIONS
  Patients that start dialysis with low levels of renal function are likely to be significantly malnourished. Whether this translates into a survival advantage requires prospective study.
authors.affiliation: Department of Renal Medicine, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cooper
authors.forename: Alireza
authors.initials: A
authors.lastname: Aslani
authors.forename: Murielle
authors.initials: M
authors.lastname: Ryan
authors.forename: Lloyd S
authors.initials: LS
authors.lastname: Ibels
authors.forename: Carol A
authors.initials: CA
authors.lastname: Pollock
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors