Clinical predictors of decline in nutritional parameters over time in ESRD.
OBJECTIVE
Inflammation and malnutrition are important features in patients with ESRD; however, data on changes in these parameters over time are scarce. This study aimed to gain insight into changes over time in serum albumin, body mass index, high-sensitivity C-reactive protein, and IL-6 in patients with ESRD and aimed to identify clinical risk factors for deterioration of these parameters.


METHODS
Data were analyzed from the Convective Transport Study, a randomized controlled trial conducted from June 2004 to January 2011, in which 714 patients with chronic ESRD were randomized to either online hemodiafiltration or low-flux hemodialysis. Albumin and body mass index were measured up to 6 years and predialysis C-reactive protein and IL-6 were measured up to 3 years in a subset of 405 participants. Rates of change in these parameters over time were estimated across strata of predefined risk factors with linear mixed-effects models.


RESULTS
Albumin and body mass index decreased and C-reactive protein and IL-6 increased over time. For every incremental year of age at baseline, the yearly excess decline in albumin was 0.003 g/dl (-0.004 to -0.002; P<0.001) and the excess decline in body mass index was 0.02 kg/m(2) per year (-0.02 to -0.01; P<0.001). In patients with diabetes mellitus, there was a yearly excess decline of 0.05 g/dl in albumin (-0.09 to -0.02; P=0.002). Compared with women, men had an excess decline of 0.03 g/dl per year in albumin (-0.06 to -0.001; P=0.05) and an excess increase of 11.6% per year in IL-6 (0.63%-23.6%; P=0.04).


CONCLUSIONS
Despite guideline-based care, all inflammatory and nutritional parameters worsened over time. The deterioration of some of these parameters was more pronounced in men, older patients, and patients with diabetes mellitus. Special focus on the nutritional status of at-risk patients by individualizing medical care might improve their prognosis.
Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands; , †Department of Nephrology and, ‡Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; , §Department of Nephrology and , ‖Institute for Cardiovascular Research, VU Medical Center, Amsterdam, The Netherlands; , ¶Academic Medical Center, Amsterdam, The Netherlands, *St. Luc Hospital, Montréal, Quebec, Canada.
Claire H
CH
den Hoedt
Michiel L
ML
Bots
Muriel P C
MP
Grooteman
Neelke C
NC
van der Weerd
E Lars
EL
Penne
Albert H A
AH
Mazairac
Renée
R
Levesque
Peter J
PJ
Blankestijn
Menso J
MJ
Nubé
Piet M
PM
ter Wee
Marinus A
MA
van den Dorpel
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016014:Linear Models; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D006435:Renal Dialysis; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
C422455:ALB protein, human; D015415:Biomarkers; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D012709:Serum Albumin; D002097:C-Reactive Protein; D000075462:Serum Albumin, Human