Clinical Predictors of Decline in Nutritional Parameters over Time in ESRD

Abstract

SummaryBackground and objectives Inflammation and malnutrition are important features in patients with ESRD; however, data on changes in these parameters over time are scarce. This study aimed to gain insight into changes over time in serum albumin, body mass index, high-sensitivity C-reactive protein, and IL-6 in patients with ESRD and aimed to identify clinical risk factors for deterioration of these parameters.Design, setting, participants, & measurements Data were analyzed from the Convective Transport Study, a randomized controlled trial conducted from June 2004 to January 2011, in which 714 patients with chronic ESRD were randomized to either online hemodiafiltration or low-flux hemodialysis. Albumin and body mass index were measured up to 6 years and predialysis C-reactive protein and IL-6 were measured up to 3 years in a subset of 405 participants. Rates of change in these parameters over time were estimated across strata of predefined risk factors with linear mixed-effects models.Results Albumin and body mass index decreased and C-reactive protein and IL-6 increased over time. For every incremental year of age at baseline, the yearly excess decline in albumin was 0.003 g/dl (20.004 to 20.002; P,0.001) and the excess decline in body mass index was 0.02 kg/m 2 per year (20.02 to 20.01; P,0.001). In patients with diabetes mellitus, there was a yearly excess decline of 0.05 g/dl in albumin (20.09 to 20.02; P=0.002). Compared with women, men had an excess decline of 0.03 g/dl per year in albumin (20.06 to 20.001; P=0.05) and an excess increase of 11.6% per year in IL-6 (0.63%-23.6%; P=0.04).Conclusions Despite guideline-based care, all inflammatory and nutritional parameters worsened over time. The deterioration of some of these parameters was more pronounced in men, older patients, and patients with diabetes mellitus. Special focus on the nutritional status of at-risk patients by individualizing medical care might improve their prognosis.

In Vitro Dialysis of Cytokine-Rich Plasma With High and Medium Cut-Off Membranes Reduces Its Procalcific Activity

“…Furthermore, IL‐6 correlates with nutritional status of dialysis patients and their psychological health, underlining its importance .…”

Risk Factors for Early Failure of Arteriovenous Vascular Access Among Patients With Type 2 Diabetes Mellitus

“…Although the record of exact duration of dialysis time was not found in these patients, we believe that longer renal replacement therapy history was associated with early access failure. It was proposed that inflammatory parameters that would worsen over time were especially more pronounced in ESRD patients with diabetes, and these then contribute to access dysfunction .…”

Latest consensus and update on protein-energy wasting in chronic kidney disease

“…Among ESRD patients who undergo maintenance hemodialysis treatment, there is a significant longitudinal decline in anthropometric nutritional parameters such as weight, muscle mass, and fat mass;[6] while inflammatory markers including C-reactive protein and pro-inflammatory cytokines such as interleukin-6 (IL-6) increase over time [7]. The decline in serum albumin concentration, the strongest mortality predictor, is affected by both nutritional derangements and heightened inflammatory status [8], and progresses with time on dialysis, known as dialysis vintage [7].…”

“…The decline in serum albumin concentration, the strongest mortality predictor, is affected by both nutritional derangements and heightened inflammatory status [8], and progresses with time on dialysis, known as dialysis vintage [7]. These changes associated with PEW are significant risk factors for weakness [9], poor responsiveness to erythropoiesis-stimulating agents, low quality of life, hospitalization, and mortality [6,7,10]. Therefore, serial assessment of nutritional status for detection and management of PEW is encouraged using scoring tools, including the subjective global assessment (SGA), the malnutrition inflammation score (MIS), and PEW definition criteria [11].…”