#3525 TRANSITION BETWEEN NUTRITION CATEGORIES IN HEMODIALYSIS PATIENTS

Abstract

Abstract Background and Aims We have previously characterized four nutritional categories in hemodialysis (HD) patients, evaluated by the method of ICNDS (Integrative Clinical Nutrition Dialysis Score) and slope of three subsequent monthly scores. Category 1 appeared to have the best and category 4 the worst nutritional status [1]. The aim of this study was to explore the association between nutritional category at dialysis initiation, survival, Length of Stay in hospital (LOS), and transition between nutrition categories up to 12 months following dialysis initiation. Methods Two hundred twenty-six patients who started dialysis between March 2009 and March 2019 were enrolled in the study. Scoring method of the ICNDS is based on the following 7 parameters: albumin, percentage post dialysis weight change, creatinine, urea, cholesterol, CRP, and Kt/V. We calculated the slope of first three subsequent monthly scores of each patient at HD commencement and 12 months later. Cox proportional hazard model was used to present differences in mortality hazard ratio (HR) during the first year in dialysis between four categories of patients. We used the analysis of variance and post hoc Bonferroni test to analyze differences in hospitalization frequency and LOS between the four categories during first year in dialysis. We used the Pearson chi-square test to analyze transition between categories between dialysis initiation and one year after. Results Baseline nutritional category is associated to all-cause mortality HR (χ2 = 16.402, df = 3, P = 0.051). Patients enrolled to category 2,3 and 4 at dialysis initiation were significantly associated with increased mortality HR compared to patients in category 1 (category 4: HR = 3.951, 95% CI 1.218-12.812, P = 0.022; category 3: HR = 2.705, 95% CI 1.126-6.497, P = 0.026; category 2: HR = 1.778, 95% CI 0.631-5.064, P = 0.027). LOS during first year in dialysis is significantly affected by patient nutritional category at dialysis initiation, (F = 4.671, df = 3, P = 0.003). LOS is lower in patients of category 1 and 2 compared with category 3 and 4 (between categories 1 and 4, P = 0.006; between categories 1 and 3, P = 0.03). Hospitalization frequency is not affected by patient nutritional category (F = 1.705, df = 3, P = 0.167). Pearson chi-square showed no differences in transition between the four categories between dialysis initiation and one year after (χ2 = 6.763, df = 3, P = 0.149). Conclusion Nutrition status at dialysis commencement is a main prognostic factor, transition between nutrition categories during first year in dialysis exists and may prove in future to be associated with patients’ survival.