Effects of nutrition on morbidity and mortality in hemodialysis patients

In 1982, we evaluated the survival of 98 hemodialysis patients and found th at malnutrition was the main risk factor for morbidity and mortality. In 19 99, we evaluated 122 patients and compared with the 1982 cohort. Most of ou r patients (95%) are African American, and the female to male ratio was sim ilar in both groups (0.9 vs. 1.1). Only 4% of the patients had a residual G FR (mean = 2.2 ml/min). The 1999 patients were older than the 1982 cohort-a mean age of 58 yr vs. 49 yr, respectively. Noncompliance increased from 5% to 15%. Drug abuse increased from 2% to 11%. Dialysis dose increased 25%. In 1982, we used cellulose acetate membranes; in 1999, polysulfone. The mea n Hct was 23% in 1982 and 32% in 1999. Serum albumin levels were not statis tically different, nor was the percent of patients eating less than 0.8 g p rotein/kg/day (29% in 1982 vs. 26% in 1999). therefore, in spite of signifi cantly higher doses of dialysis, the use of more biocompatible membranes, a nd higher hematocrits, malnutrition remains hight in hemodialysis patients. Despite aggressive nutritional support, malnutrition remains the main fact or for morbidity and mortality in these patients. Older age, noncompliance, and drug addiction also play a role.