Serum Creatinine and Albumin Decline Predict the Contraction of Nosocomial Aspiration Pneumonia in Patients Undergoing Hemodialysis

Abstract

Aspiration pneumonia (AP) is prevalent in older adults and the hemodialysis (HD) population has been getting older. Therefore, it is speculated that increasing number of HD patients would suffer from AP. However, the clinical aspects of AP in HD patients have not been elucidated. Consecutive HD patients with nosocomial AP hospitalized in our university hospital from April 2007 to December 2008 were recruited. Their clinical characteristics, risk factors for contraction, and the fatality of AP and treatment options were described. Nineteen out of 356 hospitalized HD patients had AP and 8 out of 19 AP patients died, indicating the incidence rate and fatality rate were 5.34% and 42.1%, respectively. Multiple regression analysis revealed that the risk factors for contracting AP included age, body mass index, serum creatinine levels (Cre) and the monthly decline rate of Cre. It also revealed that serum albumin (Alb) and basal total cholesterol levels, the decline rate of Alb and Cre levels, and the duration of AP were independent risk factors for fatality. Survivors were most often treated with tube feeding. Both contraction rate and fatality of nosocomial AP were high among HD patients. Both the malnutrition as well as the decline rate for nutrition and muscle volume indicated by falls in Alb and Cre, respectively, had clinical relevance in AP. Maintaining nutritional state by tube feeding and muscle volume seems to be the mainstay for the prevention and the treatment of AP in HD patients.

A new diagnostic index for sarcopenia and its association with short‐term postoperative complications in patients undergoing surgery for colorectal cancer

“…Several studies have demonstrated that Scr is strongly correlated with SMM, and that low Scr is independently associated with adverse outcomes . In particular, low Scr is associated with increased mortality in patients undergoing chronic dialysis . A large retrospective study found that a low baseline Scr level is associated with increased in‐hospital mortality in critically ill patients .…”

Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study

“…In addition, our study found a 24% reduction in infection-related death in patients with sLPD treatment. For decades, infection- and sepsis-related hospitalization and death in patients on permanent dialysis were considered a landmark of severe PEW [ 55 , 56 ]. Furthermore, the PEW inducing infection and death may be a complication that should mostly be of concern regarding patients who are on an LPD and are transitioning from CKD to ESRD.…”

Serum Creatinine Modifies Associations between Body Mass Index and Mortality and Morbidity in Prevalent Hemodialysis Patients

“…Recently, a low serum Cr level has been demonstrated as an independent risk factor in vancomycin-resistant enterococcal colonization [ 43 ] and nosocomial aspiration pneumonia [ 44 ] in HD patients. The decrease of serum Cr levels during the first 2 weeks is a risk factor of pneumonia-related mortality [ 44 ].…”

“…Recently, a low serum Cr level has been demonstrated as an independent risk factor in vancomycin-resistant enterococcal colonization [ 43 ] and nosocomial aspiration pneumonia [ 44 ] in HD patients. The decrease of serum Cr levels during the first 2 weeks is a risk factor of pneumonia-related mortality [ 44 ]. Since swallowing and chewing are closely correlated with systemic loss of skeletal muscle mass volume [ 38 ], decreased serum Cr level may be associated with sarcopenic dysphagia, an important cause of recurrent aspiration pneumonia.…”