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1. J Ren Nutr. 2012 Mar 8. [Epub ahead of print]

Malnutrition (Subjective Global Assessment) Scores and Serum Albumin Levels, but
not Body Mass Index Values, at Initiation of Dialysis are Independent Predictors
of Mortality: A 10-Year Clinical Cohort Study.

Chan M, Kelly J, Batterham M, Tapsell L.

Department of Nutrition and Dietetics, St. George Hospital, Sydney, New South
Wales, Australia; Nutrition Research, Illawarra Health and Medical Research
Institute, School of Health Sciences, University of Wollongong, Wollongong, New
South Wales, Australia; St. George Clinical School, School of Medicine,
University of New South Wales, Sydney, Australia.

OBJECTIVE: To examine the associations between demographic, clinical, lifestyle,
and nutritional parameters at the start of dialysis and mortality, including the
combined effects on nutritional parameters, which were seldom investigated in the
literature. DESIGN: Ten-year retrospective clinical cohort study. SETTING:
Dialysis unit of a metropolitan tertiary teaching hospital in Sydney, Australia.
SUBJECTS: Incident dialysis patients (n = 167; hemodialysis, 57.5%; male, 61.7%;
age, 65.3 ± 13.6 years; diabetic, 24.5%) who commenced on a planned dialysis
program. METHODS: Associations were examined between all-cause mortality and
baseline demographics, including age and gender; clinical and lifestyle
characteristics, including glomerular filtration rate, smoking habits, presence
of comorbidities (e.g., coronary artery disease, diabetes mellitus, and
peripheral vascular disease); and nutritional parameters, including body mass
index (BMI), serum albumin (s-albumin) levels, and subjective global assessment
score (SGA). Associations with combination values for malnutrition, s-albumin
(<3.3 vs. ≥3.3 g/dL), and BMI (<26 vs. ≥26 kg/m(2)) were also examined. RESULTS:
Median survival was 54.2 months (interquartile range, 23 to 83), and 52.1% of
patients were malnourished (SGA score B and C) at the start of dialysis. Advanced
age (classified as >65 years, P < .0001), presence of peripheral vascular disease
(P < .0001), reduced s-albumin levels (P = .01), and malnutrition scores (P =
.02) independently predicted mortality. Being overweight and obese (BMI: ≥26
kg/m(2)) did not show any advantage on survival (P = .73). Being malnourished and
overweight (or obese) was associated with a 3-fold increase in mortality risk
(adjusted hazard ratio [HR], 2.96; 95% confidence interval [CI], 1.12 to 7.33; P
= .02) compared with being well nourished with a BMI <26 kg/m(2) (referent).
Compared with being well nourished (SGA = A), being malnourished with normal or
low s-albumin was associated with higher risk (HR, 2.06; 95% CI, 1.06 to 4.00; P
= .03 and HR, 2.86; 95% CI, 1.65 to 4.94; P < .0001, respectively). There was no
statistical difference between mortality risks through any combination of
s-albumin and BMI values (P = .54). CONCLUSION: Malnutrition and reduced
s-albumin levels were found to be independent predictors of mortality, whereas
being overweight and obese did not show protective effects.

Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All
rights reserved.

PMID: 22406122 [PubMed - as supplied by publisher]