PREDICTIVE VALUE OF NUTRITIONAL MARKERS (ALBUMIN, CREATININE, CHOLESTEROL, AND HEMATOCRIT) FOR PATIENTS ON DIALYSIS FOR UP TO 30 YEARS

Mortality among end-stage renal disease patients in the United States remains unacceptably high despite progress in the management of renal replacement therapy, Consequently, there are few reports of long-term survivors on dialysis. We have analyzed characteristics of long-term ( 10 to 15 years, N = 40) and very long-term (15 to 30 years, N = 18) su rvivors an hemodialysis and long-term survivors (more than 10 years, N = 28) on peritoneal dialysis and compared them with ''average survivo rs'' (< 5 years, N = 65 for hemodialysis and N = 101 for peritoneal di alysis). Among hemodialysis patients, long- and very long-term surviva l was associated with younger age, nondiabetic status, black race, and male gender (P < 0.05 for all variables), Enrollment creatinine was h igher among long- and very long-term survivors, whereas albumin and he matocrit increased significantly during the period of observation amon g long- and very long-term survivors compared with average survivors, Enrollment age, nondiabetic status, and albumin level predicted prolon ged survival even after adjustments for confounding variables, Among p eritoneal dialysis patients, younger age and nondiabetic status predic ted prolonged survival. Black race was associated with improved surviv al, but the association was not statistically significant, Enrollment levels of albumin and creatinine were significantly higher among long- term survivors and the cholesterol increased during the period of obse rvation in long-term survivors, Thus, demographic end biochemical indi ces reflecting nutritional status can predict prolonged survival in he modialysis and peritoneal dialysis, patient survival for periods of up to 30 years is possible on renal replacement therapy. Analyses of the se outlier patients may after clues to prolonged survival. (C) 1996 by the National Kidney Foundation, Inc.