Multiple factors influencing mortality in hemodialysis patients

B. Yaprak, N. Arslan, H. Alataş

Department of Internal Medicine, Turgut Ozal University, Malatya Training and Research Hospital, Malatya, Turkey. hacer_alatas@hotmail.com

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• Nephrology
• Nutrition

OBJECTIVE: Both decreased food intake and elevated inflammation contribute to malnutrition in hemodialysis (HD) patients. Malnutrition, inflammation, anthropometric measurements, and other comorbidity factors were investigated in this study as potential indicators of mortality in HD patients.

PATIENTS AND METHODS: By measuring geriatric nutritional risk index (GNRI), malnutrition inflammation score (MIS), and prognostic nutritional index (PNI), 334 HD patients’ nutritional status was assessed. Through the use of four different models and logistic regression analysis, the predictors of each individual’s survival status were examined. The models were matched using the Hosmer-Lemeshow test. On the survival of patients, the effects of malnutrition indices in Model 1, anthropometric measurements in Model 2, blood parameters in Model 3, and sociodemographic characteristics in Model 4 were investigated.

RESULTS: Five years later, 286 individuals were still on hemodialysis. Patients who had a high GNRI value had a lower mortality rate in Model 1. The body mass index (BMI) value of the patients was found to be the best predictor of mortality in Model 2, and it was found that patients with high muscle percentage had a lower mortality risk. The difference in urea level measured at the beginning and end of hemodialysis was found to be the most potent predictor of mortality in Model 3, although C-reactive protein (CRP) level was also discovered to be one of the best predictors for this model. The final model, Model 4, revealed that mortality was lower in women than in men and that income status was a reliable predictor of mortality estimation.

CONCLUSIONS: The best indicator of mortality in hemodialysis patients is the malnutrition index.

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