Body composition monitor assessing malnutrition in the hemodialysis population independently predicts mortality.

OBJECTIVE: Malnutrition is a known predictor of mortality in the general and hemodialysis populations. However, diagnosing malnutrition in dialysis patients remains problematic. Body composition monitoring (BCM) is currently used mainly for assessing overhydratation in hemodialysis patients, but it also offers the possibility of evaluating nutrition status. This study explored whether malnutrition diagnosed by BCM predicts mortality at up to 54 months follow-up in prevalent hemodialysis patients. DESIGN: This was a retrospective epidemiology cohort study. Dialysis patients with baseline BCM measurement between 2008 and 2013 were enrolled. The observation period was up to 54 months follow-up. SUBJECTS: A total sample consisted of 960 chronic hemodialysis participants. INTERVENTION: All data were retrieved from medical records. Nutrition status was estimated by BCM; malnutrition was diagnosed as lean tissue index less than 10% of the normal value. MAIN OUTCOME MEASURE: Cox regression was performed to identify whether low LTI predicted mortality in hemodialysis patients. RESULTS: BCM-diagnosed malnutrition (hazard ratio [HR] 1.66; 95% confidence interval [CI] 1.1; 2.44), higher age (HR 1.05; 95% CI 1.03; 1.07), longer dialysis vintage (HR 1.00; 95% CI 1.00; 1.00), central venous catheter use (HR 1.96; 95% CI 1.28; 2.99), and low serum albumin (HR 0.91; 95% CI 0.87; 0.95) contributed significantly to the Cox regression model on mortality. CONCLUSION: BCM-diagnosed malnutrition in chronic hemodialysis patients is an independent predictor of mortality at up to 54 months follow-up and is associated with a 1.66-fold higher risk of dying compared with normal nutrition status. Whether intervention (e.g., nutritional supplementation) might improve nutrition and reduce the higher risk of mortality in malnutrition patients on hemodialysis remains a challenge for future research.

Oral use of iron with vitamin C in hemodialyzed patients.

OBJECTIVE: To investigate if oral use of Sorbifer Durules (EGIS Pharmaceutical Ltd, Budapest, Hungary) (1 tablet/d) is adequate for the maintenance of serum iron and vitamin C in normal range during recombinant human erythropoietin treatment in hemodialyzed patients. One tablet of Sorbifer Durules contains 100 mg of Fe(2+) and 60 mg of vitamin C. DESIGN: Short-term, open-label clinical trial. SETTING: Hemodialysis units. PATIENTS: Twenty-four adult patients with end-stage renal disease on hemodialysis. INTERVENTION: Four-week treatment period of Sorbifer Durules, preceded and followed by iron and vitamin C washout periods. MAIN OUTCOME MEASURE: Fasting predialysis serum samples were collected on days 0, 28, 56, and 84 to determine hematocrit, blood hemoglobin, serum iron, total iron-binding capacity, transferrin saturation, ferritin, vitamin C, and plasma oxalate. RESULTS: Four-week treatment in hemodialyzed patients by Sorbifer Durules led to significant increase of hematocrit, blood hemoglobin, serum iron and vitamin C. This treatment did not influence the level of plasma oxalate. CONCLUSION: Oral dose of one tablet of Sorbifer Durules per day is adequate for the maintenance of serum iron in normal range during recombinant human erythropoietin treatment in hemodialyzed patients. This treatment simultaneously prevented the development of serum vitamin C deficiency and did not lead to further increase of plasma oxalate in these patients.