Abstract
Markers of better nutritional status including both higher levels of serum albumin (as a measure of visceral proteins) and creatinine (as a measure of the muscle mass) are associated with lower mortality in conventional (thrice weekly) hemodialysis patients. However, data for these associations in twice-weekly hemodialysis patients, in whom less frequent hemodialysis may confound nutritional predictors, are lacking. We identified 1,113 twice-weekly and matched 4,448 thrice-weekly hemodialysis patients from a large national dialysis cohort of incident hemodialysis patients over 5years (2007-2011). Mortality risk, adjusted for potential confounders, was examined across two-by-two combinations of serum creatinine (<6 vs. ≥6mg/dL) and albumin (<3.5g/dL vs. ≥3.5g/dL) for each treatment frequency yielding a total of 8 groups. Patients were aged 70±14years and included 48% women and 55% diabetics. Using the thrice-weekly hemodialysis patients with creatinine ≥ 6mg/dL and albumin ≥ 3.5g/dL as reference, patients with creatinine <6mg/dL and albumin <3.5g/dL had a 1.8-fold higher risk of mortality (hazard ratio: 1.75, 95% confidence interval: 1.33-2.30) in twice-weekly and 2.2-fold increased risk of mortality (hazard ratio: 2.21, 95% confidence interval: 1.81-2.70) in thrice-weekly hemodialysis patients, respectively in fully adjusted models adjusted for demographics, comorbidities, and markers of malnutrition and inflammation. A test for interaction showed that there was no significant difference in albumin creatinine mortality associations between twice-weekly and thrice-weekly hemodialysis patients (P-for-interaction = .7667). Surrogate markers of higher visceral protein and muscle mass combined may confer greatest survival in both twice-weekly and thrice-weekly hemodialysis patients.
Highlights
CHRONIC KIDNEY DISEASE and end-stage renal disease (ESRD) are recognized as global public health problems.[1,2] More than 400,000 people in the United States receive hemodialysis treatment for ESRD, among whom, approximately 100,000 initiate hemodialysis each year.[3]
In ESRD patients, serum creatinine may be used as a surrogate of muscle mass,[4,5,6,7,8,9,10,11] and higher serum creatinine level has been found to be associated with better survival.[11,12,13,14]
In twice-weekly hemodialysis patients, compared with the reference group, patients in the group with the lowest levels of serum creatinine and albumin (,6.0 mg/dL and,3.5 g/dL, respectively) had a 2.9-fold increased risk of crude mortality (HR: 2.94; 95% CI: 1.92-4.52; Fig. 3, Table S3)
Summary
CHRONIC KIDNEY DISEASE and end-stage renal disease (ESRD) are recognized as global public health problems.[1,2] More than 400,000 people in the United States receive hemodialysis treatment for ESRD, among whom, approximately 100,000 initiate hemodialysis each year.[3]. §Department of Medicine, Inje University, Busan, South Korea. {Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee. **Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee. Support: The work in this article has been performed with the support of the National Institute of Diabetes,Digestive and Kidney Disease of the National.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
