Epidemiologic cohort studies of critical nutritional issues in the care of the dialysis patient: Report of the epidemiology work group

Abstract

ALNUTRITION is associated with an increased risk of death among end-stage renal disease (ESRD) patients and is a risk factor for hospitalization and impaired quality of life (Table 1).1-28 As reviewed elsewhere, this association is strongly predictive and consistent across studies, and risk increases with increasing malnutrition.“9-32 The association is consistent with our current understanding of the pathophysiology of ESRD and supported by biologically plausible mechanisms.29-32 Despite these facts, a causal role of malnutrition for mortality among ESRD patients has not been unequivocally established.29-3” This is true for several reasons. First, multiple mechanisms are responsible for malnutrition in ESRD patients, and an independent contribution of malnutrition to risk of death after controlling for these antecedent factors has not been established.29,31 For example, there are both nutritional and nonnutritional factors responsible for hypoalbuminemia in ESRD patients. 33 Inflammatory markers such as C-reactive protein and serum amyloid A are positively associated with declining serum albumin levels and are predictors of mortality.34 Second, little is known about the distribution and time-course of malnutrition among incident ESRD patients, so that it is possible that an association between nutrition abnormalities and death is a result of changes in nutritional status