Unintentional Weight Loss Is an Independent Predictor of Mortality in a Hemodialysis Population

Abstract

This study investigated common components of classification of nutrition screening risk in the prediction of clinical end-points (mortality and morbidity) in hemodialysis patients over a 3-year period (2005 to 2008). This was a retrospective cohort study. This study was conducted at a Hemodialysis centre. The study included patients on maintenance hemodialysis in June 2005. Assessment of nutrition risk was carried out using components of Protein-Energy Wasting criteria. Clinical outcome at the 3-year follow-up (June 2008) was measured as mortality and morbidity (as unplanned hospital admissions). Risk of mortality was investigated independent of comorbidities, age, gender, ethnicity, and dialysis vintage using Cox proportional hazards model. A total of 217 patients met the inclusion criteria (143 male [66%]; age, 60.5 ± 15.6 years). Patients who lost ≥5% body weight in the 6 months before the study commenced, had a 3-fold (Hazard Ratio = 3.0; 95% confidence interval: 1.2 to 7.5) independent greater risk of death (P = .02). Low serum albumin (<38 g/L) resulted in higher morbidity and mortality; however, this was not statistically significant when adjusted for confounders. Body mass index was only available in 64% (138 of 217) of the cohort at baseline, and was not related to clinical outcome at the 3-year follow-up. Unintentional weight loss is independently predictive of clinical outcome in this cohort of dialysis patients. It is recommended that nutrition screening tools include weight loss as a key component in classification of risk and for prioritizing patient care.