Nutritional status in chronic dialysis patients : associations with development of disease and survival

Abstract

The main objective of this thesis was to study the association between nutritional status and survival in end-stage renal disease patients who are maintained on a chronic dialysis treatment. Where as obesity is an established risk factor for morbidity and mortality in the general population, many survival studies in hemodialysis patients have indicated reverse associations of obesity with mortality. We showed, however, that the association between BMI and mortality in the hemodialysis population was similar, and not reversed compared with the general population of equal baseline age and duration of follow-up. Independent from BMI, weight loss and muscle mass depletion were both associated with an increased mortality risk in hemodialysis patients. Furthermore, we observed an interaction effect between protein-energy wasting, inflammation and cardiovascular disease, resulting in excess mortality in chronic dialysis patients. Finally, compared with a normal nutritional status, the short-term impact of protein-energy wasting on mortality appeared more important than the long-term effect. The results of this thesis emphasize the importance of maintaining a good nutritional status in chronic dialysis patients. The nutritional status of dialysis patients should be assessed regularly, at least every 6 months. In clinical practice, the 7-point Subjective global assessment can be used for this.