Dataset Information

Nutritional Competence and Resilience among Hemodialysis Patients in the Setting of Dialysis Initiation and Hospitalization.

ABSTRACT:

Background and objectives

Dialysis patients have a high risk for inadequate nutrition. Their nutritional status is particularly susceptible to deterioration when faced with intercurrent events such as hospitalization. This study was conducted to improve the understanding of the temporal evolution of nutritional parameters as a foundation for rational and proactive nutritional intervention.

Design, setting, participants, & measurements

A retrospective cohort study was performed to investigate the temporal evolution of nutritional parameters (serum albumin, serum phosphate, serum creatinine, equilibrated normalized protein catabolic rate, and interdialytic weight gain) and a composite nutritional score derived from these parameters, in two populations: (1) incident hemodialysis (HD) patients who started HD between January 2006 and December 2011 and were followed for up to 54 months (median 16.3), and (2) prevalent patients with HD vintage ?2.5 years who were hospitalized between January 2006 and December 2011 and followed from 6 months before to 6 months after hospitalization.

Results

In incident patients (n=126,964), each of the nutritional parameters improved after HD initiation, with a mean composite nutritional score at the 24th percentile at the start of HD and reaching a plateau at the 57th percentile toward the end of the second year on dialysis. Nutritional parameters increased more rapidly and reached higher values among patients who survived longer. In hospitalized patients (n=14,193), the nutritional parameters and the composite score began to decline 1-2 months before hospitalization, reached their lowest level in the month after hospitalization, and then partially recovered in the subsequent 5 months. The degree of recovery of the nutritional score was inversely related to the number of rehospitalizations.

Conclusions

This study increases the understanding of nutritional resilience and its determinants in HD patients. Application of the nutritional score, pending further validation, may facilitate targeted and timely interventions to avert the negative consequences of inadequate nutrition in chronic HD patients.

SUBMITTER: Thijssen S

PROVIDER: S-EPMC4559517 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

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Publications

Nutritional Competence and Resilience among Hemodialysis Patients in the Setting of Dialysis Initiation and Hospitalization.

Thijssen Stephan S Wong Michelle M Y MM Usvyat Len A LA Xiao Qingqing Q Kotanko Peter P Maddux Franklin W FW

Clinical journal of the American Society of Nephrology : CJASN 20150716 9

<h4>Background and objectives</h4>Dialysis patients have a high risk for inadequate nutrition. Their nutritional status is particularly susceptible to deterioration when faced with intercurrent events such as hospitalization. This study was conducted to improve the understanding of the temporal evolution of nutritional parameters as a foundation for rational and proactive nutritional intervention.<h4>Design, setting, participants, & measurements</h4>A retrospective cohort study was performed to ...[more]

PMID: 26185260

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Project description:BackgroundFrailty is associated with hospitalization and mortality among dialysis patients. To now, few studies have considered the degree of frailty as a predictor of hospitalization.ObjectiveWe evaluated whether frailty severity was associated with hospitalization after dialysis initiation.DesignRetrolective cohort study.SettingNova Scotia, Canada.PatientsConsecutive adult, chronic dialysis patients who initiated dialysis from January 1, 2009 to June 30, 2014, (last follow-up June, 2015).MethodsFrailty Severity, as determined by the 7-point Clinical Frailty Scale (CFS, ranging from 1 = very fit to 7 = severely frail), was measured at dialysis initiation and treated as continuous and in categories (CFS scores of 1-3, 4/5, and 6/7). Hospitalization was characterized by cumulative time admitted to hospital (proportion of days admitted/time at risk) and by the joint risk of hospitalization and death. Time at risk included time in hospital after dialysis initiation and patients were followed until transplantation or death.ResultsOf 647 patients (mean age: 62 ± 15), 564 (87%) had CFS scores. The mean CFS score was 4 ("corresponding to "vulnerable") ± 2 ("well" to "moderately frail"). In an adjusted negative binomial regression model, moderate-severely frail patients (CFS 6/7) had a >2-fold increased risk of cumulative time admitted to hospital compared to the lowest CFS category (IRR = 2.18, 95% confidence interval [CI] = 1.31-3.63). In the joint model, moderate-severely frail patients had a 61% increase in the relative hazard for hospitalization (hazard ratio [HR] = 1.61, 95% CI = 1.29-2.02) and a 93% increase in the relative hazard for death compared to the lowest CFS category (HR = 1.93, 95% CI = 1.16-3.22).LimitationsPotential unknown confounders may have affected the association between frailty severity and hospitalization given observational study design. The CFS is subjective and different clinicians may grade frailty severity differently or misclassify patients on the basis of limited availability.ConclusionsAmong incident dialysis patients, a higher frailty severity as defined by the CFS is associated with both an increased risk of cumulative time admitted to hospital and joint risk of hospitalization and death.

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Dataset Information

Nutritional Competence and Resilience among Hemodialysis Patients in the Setting of Dialysis Initiation and Hospitalization.

Background and objectives

Design, setting, participants, & measurements

Results

Conclusions

Publications

Nutritional Competence and Resilience among Hemodialysis Patients in the Setting of Dialysis Initiation and Hospitalization.

Similar Datasets

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