Patients receiving maintenance hemodialysis with low vs high levels of nutritional risk have decreased morbidity

Abstract

Objective To compare the demographic and clinical characteristics and outcomes (morbidity) of 442 patients receiving maintenance hemodialysis who are at different levels of nutritional risk. Design A retrospective, longitudinal, chart review. Setting/subjects An urban, outpatient hemodialysis unit in New York City. Subjects were stratified according to their number of nutritional risk factors: zero to one=low risk, two to three=moderate risk, four to six=high risk. Main outcome measures Mean values for serum albumin <37 g/L, creatinine <884 μmol/L, total cholesterol <4.42 mmol/L, normalized protein nitrogen appearance <0.9 g/kg/day, weight change > −2.5 kg, and body mass index <24. Morbidity indicators were frequency and duration of hospitalizations. Statistical analyses Descriptive statistics, analysis of variance, and χ 2 analysis were used to summarize data and to analyze mean differences between the groups and differences in categorical variables, respectively. Results Compared with the high-risk group, the majority of subjects in the low-risk group were younger, male, and did not have diabetes; fewer had two or more comorbidities. The high-risk group had 75% more hospitalizations and spent 195% more days in the hospital than the low-risk group. Conclusions Declining values of the nutritional risk factors and higher hospitalization rates were present in the high-risk group. Older subjects, those with diabetes, and those with two or more comorbidities comprised the majority of the high-risk group. More aggressive nutrition counseling and interventions may be needed for high-risk group members to determine if their risk for morbidity could be reduced.