Aktuelle Ernährungsmedizin 2017; 42(03): 241-272
DOI: 10.1055/s-0037-1603245
Freie Mitteilungen
Georg Thieme Verlag KG Stuttgart · New York

PREDICTION OF LONG TERM SURVIVAL BY NUTRITIONAL ASSESSMENT PARAMETERS IN HEMODIALYSIS PATIENTS

S Nafzger-Schönberg
1   Bern University of Applied Sciences, Health Division, Nutrition and Dietetics
,
K Frey
2   University Clinics of Endocrinology/Diabetology/Clinical Nutrition/Metabolism and Nephrology/Hypertension, Inselspital, Bern University Hospital
,
AB Sterchi
2   University Clinics of Endocrinology/Diabetology/Clinical Nutrition/Metabolism and Nephrology/Hypertension, Inselspital, Bern University Hospital
,
D Uehlinger
2   University Clinics of Endocrinology/Diabetology/Clinical Nutrition/Metabolism and Nephrology/Hypertension, Inselspital, Bern University Hospital
3   University of Bern, Bern, Switzerland
› Author Affiliations
Further Information

Publication History

Publication Date:
20 June 2017 (online)

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    Introduction:

    Protein-energy malnutrition (PEM) is considered a key component of the decreased life expectancy in patients on maintenance hemodialysis (MHD). Previously we evaluated changes in nutritional and anthropometric parameters concerning their relevance for assessing PEM in this patient group: Nutritional Risk Screening 2002 (NRS-2002), handgrip strength measurement (HGS), mid-upper arm muscle area (MUAMA), triceps skin fold measurement (TSF), serum albumin, normalized protein catabolic rate (nPCR), eKt/V and total Kt/V, dry body weight, body mass index (BMI), age and time since start on MHD. We then identified serum albumin as the only predictor of death and of the combined endpoint „death or weight loss of more than 5%“. Here we report our results on the predictive power of these parameters with respect to long term survival.

    Objectives:

    The aim of this study was to identify which of the above mentioned nutritional and anthropometric parameters were able to predict long term survival in hemodialysis patients.

    Methods:

    Nutritional and anthropometric parameters have been assessed in 63 hemodialysis patients (38 male and 25 female) on October 2009. This patient population was followed for more than 8 years until February 2017. Cox proportional hazard models were used to test the influence of the 12 assessed parameters on patient survival. Parameters with a significant univariate influence on the hazard were combined in a final multivariate proportional hazard model.

    Results:

    Mean age at time of assessment was 70 ± 13 years (mean ± STD). Patients had been dialyzed 4.7 ± 5.7 years prior to the measurements. 46 patients died during the observation period. Eight year patient survival after assessment was 10 ± 6%. More than 80% of the patients had a Nutritional Risk Screening 2002 (NRS-2002) of 1. Only patient age (P < 0.0066), serum albumin (P < 0.0004) and HGS (P < 0.0103) showed a significant univariate influence on the hazard. Combining these 3 parameters in a proportional hazard model, revealed a nonsignificant influence of age (P < 0.1062) on the model. The final model combines the influences of HGS (P < 0.0374 and serum albumin (P < 0.0210) on patient survival.

    Conclusion:

    Serum albumin levels and HGS measurements may independently predict long term survival of hemodialysis patients.

    References:

    Nafzger, S, Fleury, LA, Uehlinger, DE, Plüss P, Scura N, Kurmann S. Detection Of Malnutrition In Patients Undergoing Maintenance Haemodialysis: A Quantitative Data Analysis On 21 Parameters. J Ren Care. 2015 Sep; 41(3):168 – 76.

    Disclosure of Interest:

    None declared.


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    No conflict of interest has been declared by the author(s).