TY - JOUR
T1 - Clinical predictors of decline in nutritional parameters over time in ESRD
AU - den Hoedt, Claire H.
AU - Bots, Michiel L.
AU - Grooteman, Muriel P. C.
AU - van der Weerd, Neelke C.
AU - Penne, E. Lars
AU - Mazairac, Albert H. A.
AU - Levesque, Renée
AU - Blankestijn, Peter J.
AU - Nubé, Menso J.
AU - ter Wee, Piet M.
AU - van den Dorpel, Marinus A.
AU - AUTHOR GROUP
AU - Dorval, M.
AU - Lévesque, R.
AU - Koopman, M. G.
AU - Konings, C. J. A. M.
AU - Haanstra, W. P.
AU - Kooistra, M.
AU - van Jaarsveld, B.
AU - Noordzij, T.
AU - Feith, G. W.
AU - Peltenburg, H. G.
AU - van Buren, M.
AU - Offerman, J. J. G.
AU - Hoogeveen, E. K.
AU - de Heer, F.
AU - van de Ven, P. J.
AU - Kremer Hovinga, T. K.
AU - Bax, W. A.
AU - Groeneveld, J. O.
AU - Lavrijssen, A. T. J.
AU - Schrander-van der Meer, A. M.
AU - Reichert, L. J. M.
AU - Huussen, J.
AU - Rensma, P. L.
AU - Schrama, Y.
AU - van Hamersvelt, H. W.
AU - Boer, W. H.
AU - van Kuijk, W. H.
AU - Vervloet, M. G.
AU - Wauters, I. M. P. M. J.
AU - Sekse, I.
PY - 2014
Y1 - 2014
N2 - Inflammation and malnutrition are important features in patients with ESRD; however, data on changes in these parameters over time are scarce. This study aimed to gain insight into changes over time in serum albumin, body mass index, high-sensitivity C-reactive protein, and IL-6 in patients with ESRD and aimed to identify clinical risk factors for deterioration of these parameters. Data were analyzed from the Convective Transport Study, a randomized controlled trial conducted from June 2004 to January 2011, in which 714 patients with chronic ESRD were randomized to either online hemodiafiltration or low-flux hemodialysis. Albumin and body mass index were measured up to 6 years and predialysis C-reactive protein and IL-6 were measured up to 3 years in a subset of 405 participants. Rates of change in these parameters over time were estimated across strata of predefined risk factors with linear mixed-effects models. Albumin and body mass index decreased and C-reactive protein and IL-6 increased over time. For every incremental year of age at baseline, the yearly excess decline in albumin was 0.003 g/dl (-0.004 to -0.002; P <0.001) and the excess decline in body mass index was 0.02 kg/m(2) per year (-0.02 to -0.01; P <0.001). In patients with diabetes mellitus, there was a yearly excess decline of 0.05 g/dl in albumin (-0.09 to -0.02; P=0.002). Compared with women, men had an excess decline of 0.03 g/dl per year in albumin (-0.06 to -0.001; P=0.05) and an excess increase of 11.6% per year in IL-6 (0.63%-23.6%; P=0.04). Despite guideline-based care, all inflammatory and nutritional parameters worsened over time. The deterioration of some of these parameters was more pronounced in men, older patients, and patients with diabetes mellitus. Special focus on the nutritional status of at-risk patients by individualizing medical care might improve their prognosis
AB - Inflammation and malnutrition are important features in patients with ESRD; however, data on changes in these parameters over time are scarce. This study aimed to gain insight into changes over time in serum albumin, body mass index, high-sensitivity C-reactive protein, and IL-6 in patients with ESRD and aimed to identify clinical risk factors for deterioration of these parameters. Data were analyzed from the Convective Transport Study, a randomized controlled trial conducted from June 2004 to January 2011, in which 714 patients with chronic ESRD were randomized to either online hemodiafiltration or low-flux hemodialysis. Albumin and body mass index were measured up to 6 years and predialysis C-reactive protein and IL-6 were measured up to 3 years in a subset of 405 participants. Rates of change in these parameters over time were estimated across strata of predefined risk factors with linear mixed-effects models. Albumin and body mass index decreased and C-reactive protein and IL-6 increased over time. For every incremental year of age at baseline, the yearly excess decline in albumin was 0.003 g/dl (-0.004 to -0.002; P <0.001) and the excess decline in body mass index was 0.02 kg/m(2) per year (-0.02 to -0.01; P <0.001). In patients with diabetes mellitus, there was a yearly excess decline of 0.05 g/dl in albumin (-0.09 to -0.02; P=0.002). Compared with women, men had an excess decline of 0.03 g/dl per year in albumin (-0.06 to -0.001; P=0.05) and an excess increase of 11.6% per year in IL-6 (0.63%-23.6%; P=0.04). Despite guideline-based care, all inflammatory and nutritional parameters worsened over time. The deterioration of some of these parameters was more pronounced in men, older patients, and patients with diabetes mellitus. Special focus on the nutritional status of at-risk patients by individualizing medical care might improve their prognosis
U2 - https://doi.org/10.2215/CJN.04470413
DO - https://doi.org/10.2215/CJN.04470413
M3 - Article
C2 - 24458074
SN - 1046-6673
VL - 9
SP - 318
EP - 325
JO - Clinical journal of the American Society of Nephrology
JF - Clinical journal of the American Society of Nephrology
IS - 2
ER -