Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients.
BACKGROUND
Malnutrition-inflammation complex syndrome, an outcome predictor in maintenance hemodialysis (MHD) patients, may be related to anorexia.


OBJECTIVE
We examined whether subjectively reported appetite is associated with adverse conditions and increased morbidity and mortality in MHD patients.


METHODS
A cohort of 331 MHD outpatients was asked to rate their recent appetite status on a scale from 1 to 4 (very good, good, fair, and poor appetite, respectively). Anemia indexes and nutritional and inflammatory markers-including serum concentrations of C-reactive protein, tumor necrosis factor alpha, and interleukin 6-were measured. The malnutrition-inflammation score was used to evaluate the malnutrition-inflammation complex syndrome, and the SF36 questionnaire was used to assess quality of life (QoL). Mortality and hospitalization were followed prospectively for up to 12 mo.


RESULTS
Patients were aged 54.5 +/- 14.4 y. Diminished appetite (fair to poor) was reported by 124 patients (38%). Hemoglobin, protein intake, and QoL scores were progressively lower, whereas markers of inflammation, malnutrition-inflammation scores, and the required erythropoietin dose were higher across the worsening categories of appetite. The adjusted odds ratios of diminished versus normal appetite for increased serum tumor necrosis factor alpha and C-reactive protein concentrations were significant. Significant associations between a poor appetite and an increased rate of hospitalization and mortality were observed. The hazard ratio of death for diminished appetite was 4.74 (95% CI: 1.85, 12.16; P = 0.001).


CONCLUSIONS
Diminished appetite (anorexia) is associated with higher concentrations of proinflammatory cytokines and higher levels of erythropoietin hyporesponsiveness and poor clinical outcome, including a 4-fold increase in mortality, greater hospitalization rates, and a poor QoL in MHD patients. Appetite status may yield significant insight into the clinical status of dialysis patients.
Division of Nephrology and Hypertension, Harbor-University of California, Los Angeles Medical Center, Harbor Mailbox 406, 1000 West Carson Street, Torrance, CA 90509-2910, USA. kamkal@ucla.edu
Kamyar
K
Kalantar-Zadeh
Gladys
G
Block
Charles J
CJ
McAllister
Michael H
MH
Humphreys
Joel D
JD
Kopple
D000328:Adult; D000704:Analysis of Variance; D000740:Anemia / Q000097:blood / Q000150:complications*; D000855:Anorexia / Q000097:blood / Q000209:etiology* / Q000401:mortality; D001066:Appetite; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome