PREALBUMIN IS THE BEST NUTRITIONAL PREDICTOR OF SURVIVAL IN HEMODIALYSIS AND PERITONEAL-DIALYSIS

Patients undergoing dialytic therapy for end-stage renal disease (ESRD ) have greater morbidity and mortality than age-matched individuals wi th similar demographics in the general population. Risk factors for ea rly death during treatment for ESRD include advanced age, diabetes, hy pertension, and malnutrition, We questioned whether the level of serum prealbumin at the start of uremia therapy might serve as a marker of subsequent survival in patients treated with maintenance hemodialysis (HD) and peritoneal dialysis (PD). Study cohorts included 111 HD and 7 8 PD patients followed for up to 5 years. Selected demographic charact eristics and biochemical variables were tested for correlation with su rvival in each cohort. Variables evaluated included age, race, gender, diabetic status, and serum concentrations of albumin, creatinine, cho lesterol, and prealbumin. For comparison, expected survival was calcul ated with Cox proportional hazards analysis, which accounts for confou nding variables, We found that a higher relative risk (RR) of death in HD patients correlated with older age, the diagnosis of diabetes, and a serum prealbumin < 30 mg/dL. In PD patients, older age and the pres ence of diabetes correlated with a higher RR of death than in the stan dard population. When nutritional variables were analyzed separately, prealbumin < 30 mg/dL was the strongest variable that predicted mortal ity in HD patients (RR = 2.64, P = 0.002) and also predicted increased risk of mortality in PD patients (RR = 1.8, P = 0.035). Observed and expected survival was significantly higher in patients with enrollment prealbumin greater than 30 mg/dL in both HD and PD, The serum prealbu min level correlated significantly with other measures of nutrition, i ncluding serum albumin, serum creatinine, and serum cholesterol, in bo th HD and PD patients, Among tested markers of nutritional status, pre albumin level appears to be the single best nutritional predictor of s urvival in ESRD patients. (C) 1996 by the National Kidney Foundation, Inc.