title: Nutritional Competence and Resilience among Hemodialysis Patients in the Setting of Dialysis Initiation and Hospitalization.
abstract: OBJECTIVE
  Dialysis patients have a high risk for inadequate nutrition. Their nutritional status is particularly susceptible to deterioration when faced with intercurrent events such as hospitalization. This study was conducted to improve the understanding of the temporal evolution of nutritional parameters as a foundation for rational and proactive nutritional intervention.
  
  
  METHODS
  A retrospective cohort study was performed to investigate the temporal evolution of nutritional parameters (serum albumin, serum phosphate, serum creatinine, equilibrated normalized protein catabolic rate, and interdialytic weight gain) and a composite nutritional score derived from these parameters, in two populations: (1) incident hemodialysis (HD) patients who started HD between January 2006 and December 2011 and were followed for up to 54 months (median 16.3), and (2) prevalent patients with HD vintage ≥2.5 years who were hospitalized between January 2006 and December 2011 and followed from 6 months before to 6 months after hospitalization.
  
  
  RESULTS
  In incident patients (n=126,964), each of the nutritional parameters improved after HD initiation, with a mean composite nutritional score at the 24th percentile at the start of HD and reaching a plateau at the 57th percentile toward the end of the second year on dialysis. Nutritional parameters increased more rapidly and reached higher values among patients who survived longer. In hospitalized patients (n=14,193), the nutritional parameters and the composite score began to decline 1-2 months before hospitalization, reached their lowest level in the month after hospitalization, and then partially recovered in the subsequent 5 months. The degree of recovery of the nutritional score was inversely related to the number of rehospitalizations.
  
  
  CONCLUSIONS
  This study increases the understanding of nutritional resilience and its determinants in HD patients. Application of the nutritional score, pending further validation, may facilitate targeted and timely interventions to avert the negative consequences of inadequate nutrition in chronic HD patients.
authors.affiliation: Renal Research Institute, New York, New York; sthijssen@rriny.com.
authors.forename: Stephan
authors.initials: S
authors.lastname: Thijssen
authors.affiliation: Renal Research Institute, New York, New York;
authors.forename: Michelle M Y
authors.initials: MM
authors.lastname: Wong
authors.affiliation: Fresenius Medical Care North America, Waltham, Massachusetts; and.
authors.forename: Len A
authors.initials: LA
authors.lastname: Usvyat
authors.affiliation: Renal Research Institute, New York, New York;
authors.forename: Qingqing
authors.initials: Q
authors.lastname: Xiao
authors.affiliation: Renal Research Institute, New York, New York; Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.affiliation: Fresenius Medical Care North America, Waltham, Massachusetts; and.
authors.forename: Franklin W
authors.initials: FW
authors.lastname: Maddux
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D055500:Resilience, Psychological; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors; D015430:Weight Gain
chemical_list: D010710:Phosphates; D012709:Serum Albumin; D003404:Creatinine
keywords: hemodialysis; hospitalization; nutrition; survival