MARKERS FOR SURVIVAL IN DIALYSIS - A 7-YEAR PROSPECTIVE-STUDY

Serum biochemical markers suggestive of undernutrition are directly co rrelated with mortality in hemodialysis and peritoneal dialysis patien ts. In particular, serum albumin is the most powerful predictor of sur vival. We have prospectively examined the relationship of single basel ine measurements of serum albumin, cholesterol, creatinine, apoprotein s, and prealbumin in 250 hemodialysis patients and 140 patients mainta ined on continuous ambulatory peritoneal dialysis (CAPD) monitored up to 7 years (1987 to 1994). Other variables studied included age, race, gender, diabetes, and number of months on dialysis. Observed survival was computed by the Kaplan-Meier method. Cox's proportional hazards m odel was used to determine independent predictors of mortality risk. A ge, diabetes, prior months on dialysis, and low levels of serum albumi n, creatinine, and cholesterol were important and independent predicto rs of mortality risk in hemodialysis patients. For peritoneal dialysis patients, the independent predictors of mortality risk were age, diab etes, and low serum albumin and serum creatinine. Prealbumin, a serum protein with rapid turnover and relatively small pool, was an importan t and independent risk predictor in both hemodialysis and CAPD patient s. In addition, prealbumin was more highly correlated with other nutri tional markers than was albumin. In summary, these findings suggest th at biochemical measures associated with visceral and somatic protein d epletion are predominant long-term mortality risk factors in patients maintained on hemodialysis and CAPD. (C) 1995 by the National Kidney F oundation, Inc.