title: Potential impact of nutritional intervention on end-stage renal disease hospitalization, death, and treatment costs.
abstract: OBJECTIVE
  Our objective was to estimate the effect of an improvement in nutrition, represented by albumin concentrations, on hospitalization, mortality, and Medicare end-stage renal disease (ESRD) program cost.
  
  
  METHODS
  Based on published trials, the impact of an improvement in serum albumin of +0.2 g/dL from a hypothetical nutritional program for severely malnourished patients with albumin < or = 3.5 g/dL (base case) was estimated by reassigning patients to higher albumin categories, along with outcome risks associated with the new albumin category.
  
  
  METHODS
  Data from Fresenius Medical Care North America (Waltham, MA) were utilized in regression models to determine the association between albumin and change in albumin concentration with outcomes.
  
  
  RESULTS
  Albumin < or = 3.5 g/dL was associated with a > 2-fold increase in death and hospitalization risk, compared to > or = 4 g/dL (P < .001) in this population. An increase in albumin concentration was associated with a lower risk of death and hospitalization, whereas a declining albumin concentration led to worse outcomes. Projections for the United States dialysis population from the base case showed approximately 1400 lives saved, approximately 6000 hospitalizations averted, and approximately $36 million in Medicare cost savings resulting from a reduction of approximately 20,000 hospital days. A sensitivity analysis, varying the albumin response to +0.1 and +0.3 g/dL combined with varying albumin responder rates to 25% and 75% of patients, revealed robust results.
  
  
  CONCLUSIONS
  Nutritional interventions that increase serum albumin by > or = 0.2 g/dL (e.g., via oral nutritional supplements) may lead to considerable improvements in mortality, hospitalization, and treatment costs.
authors.affiliation: Fresenius Medical Care North America, Waltham, Massachusetts 02451-1457, USA. elacsonj@fmc-na.com <elacsonj@fmc-na.com>
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lacson
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
authors.forename: J Michael
authors.initials: JM
authors.lastname: Lazarus
authors.forename: Ming
authors.initials: M
authors.lastname: Teng
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Hakim
mesh_terms: D015415:Biomarkers / Q000097:blood; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D018529:Nutritional Support / Q000191:economics* / Q000379:methods; D012044:Regression Analysis; D006435:Renal Dialysis / Q000191:economics / Q000379:methods; D018570:Risk Assessment; D012709:Serum Albumin / Q000032:analysis*; D016896:Treatment Outcome; D014481:United States
chemical_list: D015415:Biomarkers; D012709:Serum Albumin