title: Uremic malnutrition is a predictor of death independent of inflammatory status.
abstract: BACKGROUND
  Several studies have pointed out the influence of nutritional parameters and/or indices of inflammation on morbidity and mortality. Often, these conditions coexist, and the relative importance of poor nutritional status and chronic inflammation in terms of predicting clinical outcomes in chronic hemodialysis (CHD) patients has not been clarified.
  
  
  METHODS
  We undertook a prospective cohort study analyzing time-dependent changes in several established nutritional and inflammatory markers, and their influence on mortality in 194 CHD patients (53% male, 36% white, 30% with diabetes mellitus, mean age 55.7 +/- 15.4 years) throughout a 57-month period. Serial measurements of serum concentrations of albumin, prealbumin, creatinine, transferrin, cholesterol, and C-reactive protein (CRP), as well as normalized protein catabolic rate, postdialysis weight, and phase angle and reactance by bioelectrical impedance analysis were performed every 3 months. Clinical outcomes were simultaneously assessed using indicators of mortality.
  
  
  RESULTS
  Serum albumin, serum prealbumin, serum creatinine, and phase angle were significant predictors of all-cause mortality, even after adjustment for serum CRP concentrations. Serum CRP concentrations were not significantly associated with mortality. Serum albumin concentrations and phase angle were also independent predictors of cardiovascular deaths in the multivariate model.
  
  
  CONCLUSIONS
  The nutritional status of CHD patients predicts mortality independent of concomitant presence or absence of inflammatory response. Prevention of, and timely intervention to treat uremic malnutrition by suitable means are necessary independent of the presence and/or therapy of inflammation in terms of improving clinical outcomes in CHD patients.
authors.affiliation: Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2372, USA.
authors.forename: Lara B
authors.initials: LB
authors.lastname: Pupim
authors.forename: Kayser
authors.initials: K
authors.lastname: Caglar
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Hakim
authors.forename: Yu
authors.initials: Y
authors.lastname: Shyr
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000401:mortality; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D008875:Middle Aged; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D013997:Time Factors; D014511:Uremia / Q000150:complications*
chemical_list: D015415:Biomarkers