Nutritional status at dialysis initiation correlates with long-term survival
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For up to 5 years following renal replacement therapy, nutritional status at dialysis initiation is associated with long-term survival, according to data published in the Journal of Renal Nutrition.
Further, improving nutritional status during the first few months of dialysis might improve survival during the 3 years following renal replacement therapy.
“Nutritional status has been shown to affect the survival of dialysis patients. However, most previous studies have been conducted on patients undergoing hemodialysis treatment for at least 8 weeks. To date, there have been only a limited number of studies that considered the association between clinical outcome, and baseline nutritional status at the initiation of dialysis and any changes after dialysis start,” Sara Blumberg Benyamini, PhD, from the nephrology and hypertension department at E. Wolfson Medical Center in Holon, Israel, and colleagues wrote. “The aim of the current study was to explore how baseline nutritional status at dialysis initiation, and the improvement or worsening of nutritional status during the first 3 months in dialysis, affect survival for up to 5 years after the start of renal replacement therapy.”
In a retrospective observational study, researchers assessed the nutritional status of 297 patients who initiated dialysis between March 1, 2009, and March 1, 2019, with The Integrative Clinical Nutrition Dialysis Score (ICNDS) method. Researchers determined the first three monthly ICNDS slopes for each patient to measure the improvement or worsening of nutrition status. Benyamini and colleagues tested the baseline ICNDS and following 3-month slopes for association with odds of all-cause mortality for each of the first 5 years on dialysis.
Analyses revealed a “significant difference” in survival odds after 1 year of dialysis between those who initiated with an ICNDS of at least 75 and those who initiated with an ICNDS lower than 75. Additionally, a negative ICNDS slope correlated with increased mortality during 1 to 3 years after dialysis initiation, whereas a positive slope indicated improved or stable nutritional status.
“The results of our study confirm that the nutritional status at commencement of hemodialysis and the change in nutritional status over the first 3 months on dialysis are major prognostic long-term survival factors,” Benyamini and colleagues wrote. “The results of our research call for special attention for pre-dialysis care. We suggest a multidisciplinary approach that includes attention to diet and provision of adequate treatment for comorbidities in the period before initiation of dialysis, with the aim of increasing the ICNDS during the transition to renal replacement therapy.”
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