Influence of nutritional factors and hemodialysis adequacy on the survivalof 1,610 French patients

Nutritional factors and dialysis adequacy are associated with outcome in he modialyzed patients, but their relative contribution remains controversial, particularly when dialysis adequacy complies with current recommendations (Kt/V >1.2). Survival, clinical, and nutritional data from a cohort of prev alent 1,610 patients treated by hemodialysis in 20 centers in France have b een collected over a 2.5-year period, from January 1996 to July 1998. Data including age, sex, cause of end-stage renal disease (ESRD), clinical outco me, time on dialysis, body mass index (BMI), blood levels of midweek predia lysis albumin, prealbumin, and bicarbonate were analyzed. Normalized protei n catabolic rate (nPCR), dialysis adequacy parameters, and estimation of le an body mass (LBM) from creatinine generation were computed from pre and po stdialysis urea and creatinine levels. The characteristics of the patients were as follows: age 59.6 +/- 16.5 years, 58.8% males, 11% of diabetics, ti me on dialysis 63.2 +/- 64.5 m. Weekly dialysis time was 12.18 +/- 1.78 hrs , Kt/V 1.34 +/- 0.34, nPCR 1.10 +/- 0.35 g/kg body weight/day. Albumin conc entration was 39.4 +/- 5.3 g/L, prealbumin was 0.33 +/- 0.09 g/L, BMI was 2 3.0 +/- 4.5 kg/m(2). Overall survival was 89.7% +/- 0.8% and 78.4% +/- 1.1% after 1 and 2 years. In the Cox proportional hazard model, survival was si gnificantly influenced by age, the presence of diabetes, and by concentrati ons of albumin and prealbumin, but not by other variables, including Kt/V a nd urea reduction ratio. These results indicate that nutritional protein co ncentrations were predictive of dialysis outcome, whereas variables reflect ing actual body composition and dialysis dose were not. Furthermore, in thi s well-dialyzed population, dialysis adequacy had no influence on survival. In conclusion, when adequacy targets are met in hemodialyzed patients, sur vival is mainly dependent on age and nutritional status. Efforts should be focused on the most efficient ways to maintain nutritional status in these patients. (C) 2001 by the National Kidney Foundation, Inc.