Nutritional status, comorbidity and inflammation in hemodialysis patients

Low y serum albumin and high C-reactive protein ICRP) have been shown to be significant predictors of mortality in hemodialysis (HD) patients. Althoug h hypoalbuminemia has been attributed to malnutrition, it has recently been recognized evidence of inflamation that predicts serum albumin concentrati on in dialysis patients. Aim: To establish, in our HD patients, the factors associated with malnutri tion, hypoalbuminemia and elevated levels of C-reactive protein to determin e its in fluence in the incidence and cause of death during a one year foll ow-up period. Methods: A cross sectional study was performed in 64 patients (35 males, 13 % diabetics; mean age 64 +/- 12), who had beep on HD for 64 +/- 58 months. We assesed nutritional status by anthropometric and biochemical parameters and estimated protein and calorie intake by diet recall. The dialysis dose was measure by KT/V normalized for actual and ideal body weigthr (BW). Como rbidity (total and cardiovascular) were measured using a modified M. Charls on index. CRP was used as a marker of inflammation. During a one year follo w-up period we determined the incidence and cause of death. Results: According to Bilbrey index only seven patients (11 %) were well no urished. The variables associated with malnutrition were civil status (not married) and dialysis dose estimated by KT/V normalizated to ideal BW Serum albumin (mean 4.1 +/- 0.3 k/dl) was associated with creatinine, comorbidit y age and infection. 37.5% of the patients had CRP > I mg/dl and they had m ore cardiovascular comorbidity and lower serum albumin, and they used highe r doses of erythropoietin (table ill). Patients using modified cellulosic m embranes had higher levels of CRF! Multivariate analysis showed that high g lobal comorbidity, low serum cholesterol, and high level of CRP and hematoc rit predicted death. The principal cause of mortality was infection. Conclusions: Malnutrition is a common problem in HD patients. Low dialysis dose is associated with malnutrition in some patients. We propose to normal ize urea clearances to ideal body weigth. inflammatory activity is frecuent in HD, probably as a result of intermitent activation of the acute phase r esponse during the dialysis procedure. Low serum albumin in HD patients is principally associated with injection/inflammation but not with malnutritio n. CRP is a sensitive marker of inflammation and an power predictor of mort ality in HD patients.