EFFECTS OF INCREASING DIALYSIS DOSE ON SERUM-ALBUMIN AND MORTALITY INHEMODIALYSIS-PATIENTS

Dialysis dose and malnutrition have a great impact on the clinical out come of chronic hemodialysis patients. The interrelationships between them, however, remain undefined. Thus, we performed a study to determi ne the effects of increasing the dialysis dose on serum albumin concen trations and mortality in hemodialysis patients. We examined urea kine tic modeling, biochemical nutritional indices, comorbid conditions, pa tient survival time, and annual mortality rate. Dialysis dose, measure d by Kt/V, significantly increased from 1.3 +/- 0.3 in 1987 to 1.5 +/- 0.4 in 1990 and to 1.7 +/- 0.4 in 1993. Serum albumin level also incr eased, from 3.8 +/- 0.4 g/dL in 1987 to 4.0 +/- 0.4 g/dL in 1990 and t o 4.3 +/- 0.3 g/dL in 1993. In 1993, 76% of patients had Kt/V greater than or equal to 1.50 compared with 45% in 1990 and 28% in 1987, where as 82% of patients had a serum albumin level 4.0 g/dL in 1993 compared with 58% in 1990 and 29% in 1987. Protein catabolic rate and hematocr it also increased from 1987 to 1993, but not serum cholesterol or trig lyceride. The annual mortality rate declined from 16.1% in 1987 to 13. 2% in 1990 and to 8.0% in 1993. The decrease in mortality appeared to be unrelated to differences in patient selection or comorbid condition s. Serum albumin levels, hematocrit, Kt/V, and protein catabolic rate were significantly related to patient survival after age, sex, and dia betic status had been adjusted. Furthermore, there was a positive corr elation between Kt/Vs and serum albumin concentrations (r = 0.216, P < 0.001). Thus, it appears that increasing the dose of dialysis improve s serum albumin levels and perhaps survival rate in hemodialysis patie nts as well. (C) 1996 by the National Kidney Foundation, Inc.