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Study assesses impact of inflammation, malnutrition on survival of patients with ESRD
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When presented together, malnutrition, fluid overload and resulting inflammation can have a detrimental effect on survival among patients with ESRD, according to a study by researchers from the Netherlands and the United States. However, malnutrition as a singular risk factor “was not associated with increased mortality risk,” the study authors noted. “The highest mortality risk was observed in patients where all three risk factors were present.”
The study was undertaken to understand the influence of fluid overload (FO) when combined with other factor that impact mortality.
“... although the relation between FO and outcome in dialysis is well accepted, this parameter is often interpreted in isolation, whereas it may be part of a wider
syndrome of adverse risk factors, such as protein energy wasting or inflammation, which may warrant additional interventions,” wrote Marijke J. E. Dekker, MD, from Maastricht University Medical Center in the Netherlands, colleagues and researchers from Fresenius Medical Care and the Renal Research Institute.
The study included 8,883 patients on hemodialysis from both the United States and Europe (part of the Monitoring Dialysis Outcome Initiative cohort). The main outcome measure - body composition, nutritional and inflammation status - was assessed during a 3-month baseline period, and all-cause mortality was noted during 1-year follow-up.
Results showed 11.6% of patients did not have any of the three risk factors and 6.5% of patients were only malnourished, which was not associated with an increased risk of death; but the combination of severe malnutrition, FO and inflammation comprised the highest risk of death.
“... this study shows that the risk of FO increases incrementally with more severe depletion of lean tissue and/or fat tissue compartments according to (multifrequency bioimpedance spectroscopy) and is further aggravated by the presence of inflammation,” the authors concluded. “Whereas these dimensions have independent prognostic significance, as well as in combination, these different dimensions may carry a multiplicative hazard in the dialysis population.” With the presence of FO often a part of a wider syndrome of adverse risk factors, “[w]e therefore suggest, based on these results, to not interpret FO as a singular risk factor and always address nutritional and inflammatory status. We also believe this approach can assist the clinician to help identify patients with an adverse prognosis,” the authors wrote. – by Mark E. Neumann
Disclosures: The authors report no relevant financial disclosures.
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