NUTRITIONAL FACTORS AFFECTING SURVIVAL AN D MORBIDITY IN HEMODIALYSIS-PATIENTS

The objective of this study was to analyze risk nutritional factors af fecting mortality and morbidity rates in hemodialysis patients. Nutrit ional status was stablished in clinical, anthropometrical, biochemical and urea kinetic basis. We analyzed those longitudinal data obtained, every four months, from september 1990 to march 1993, of all hemodial ysis patients of an Hospital Dialysis Unit. Over the 30 months period, 131 hemodialysis patients, 79 males and 52 females, aged between 24 a nd 80 years, 55,4 +/- 15 (M +/- SD) years old, were studied. Primary r enal disease was: 15,7% Primary Glomerulonephritis (GN); 3,9% Secondar y GN; 20,5% Interstitial Nephritis; 10,2% Polycystic Kidneys; 7,9% Nep hrosclerosis; 13,4% Diabetes Mellitus; 11% all others. All patients we re dialyzed with bicarbonate as buffer; 17% was on acetate free biofil tration; 47,2% with cellulosic membranes; 30,2% AN69; 12,2% Polysulfon e; 7,5% Cellulose triacetate; 2,8% Polyamid. Usual blood flow range be tween 350-400 ml/min and dialysis time was around 180 min. Mean KT/V a nd PCR in males was 1,05 and 1, 13 g/kg/d, and 1,05 and 1,25 in female s, respectively. Males were 2,1% under their ideal weigh, and females 7,2% over, as mean. The number of patients dying, undergoing kidney tr ansplantation, or being transferred was 28, 16 and 2, respectively. To evaluate death risk logistic regression analysis for ten variables wa s applied: age, sex, dialysis length, weight/height2, triceps skinfold , mid-upper arm muscle circumference (MAMC), serum albumin, creatinine and transferrin, TAC, PCR, KT/V. This analysis produced a highly stat istically significant model to predict mortality, p < 0.001. Low serum creatinine and albumin were associated with high death risk. MAMC was the most significant anthropometric parameter and TAC, not PCR, betwe en urea kinetic ones. During the follow up period biochemical factors did not change significantly, while MAMC was lower at beginning and de creased significantly, more in patients who dead than in the others. H ospitalization rates directly correlated with decrease of anthropometr ic parameters. Low PCR is a cause for hospitalization, but not an inde pendent risk factor. Protein-caloric malnutrition in the chronic hemod ialysis population is associated with high death risk.