Jialin Wang1, Elani Streja2, Melissa Soohoo2, Joline L T Chen3, Connie M Rhee2, Taehee Kim4, Miklos Z Molnar5, Csaba P Kovesdy6, Rajnish Mehrotra7, Kamyar Kalantar-Zadeh8. 1. Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Division of Nephrology, Tianjin Union Medical Center, Tianjin, China. 2. Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California. 3. Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Division of Nephrology, Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California. 4. Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Department of Medicine, Inje University, Busan, South Korea. 5. Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee. 6. Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee. 7. Harborview Medical Center and Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington. 8. Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Division of Nephrology, Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California. Electronic address: kkz@uci.edu.
Abstract
OBJECTIVE: Markers of better nutritional status including both higher levels of serum albumin (as a measure of visceral proteins) and creatinine (as a measure of the muscle mass) are associated with lower mortality in conventional (thrice weekly) hemodialysis patients. However, data for these associations in twice-weekly hemodialysis patients, in whom less frequent hemodialysis may confound nutritional predictors, are lacking. DESIGN AND SUBJECTS: We identified 1,113 twice-weekly and matched 4,448 thrice-weekly hemodialysis patients from a large national dialysis cohort of incident hemodialysis patients over 5 years (2007-2011). Mortality risk, adjusted for potential confounders, was examined across two-by-two combinations of serum creatinine (<6 vs. ≥6 mg/dL) and albumin (<3.5 g/dL vs. ≥3.5 g/dL) for each treatment frequency yielding a total of 8 groups. RESULTS: Patients were aged 70 ± 14 years and included 48% women and 55% diabetics. Using the thrice-weekly hemodialysis patients with creatinine ≥ 6 mg/dL and albumin ≥ 3.5 g/dL as reference, patients with creatinine <6 mg/dL and albumin <3.5 g/dL had a 1.8-fold higher risk of mortality (hazard ratio: 1.75, 95% confidence interval: 1.33-2.30) in twice-weekly and 2.2-fold increased risk of mortality (hazard ratio: 2.21, 95% confidence interval: 1.81-2.70) in thrice-weekly hemodialysis patients, respectively in fully adjusted models adjusted for demographics, comorbidities, and markers of malnutrition and inflammation. A test for interaction showed that there was no significant difference in albumin creatinine mortality associations between twice-weekly and thrice-weekly hemodialysis patients (P-for-interaction = .7667). CONCLUSIONS: Surrogate markers of higher visceral protein and muscle mass combined may confer greatest survival in both twice-weekly and thrice-weekly hemodialysis patients.
OBJECTIVE: Markers of better nutritional status including both higher levels of serum albumin (as a measure of visceral proteins) and creatinine (as a measure of the muscle mass) are associated with lower mortality in conventional (thrice weekly) hemodialysis patients. However, data for these associations in twice-weekly hemodialysis patients, in whom less frequent hemodialysis may confound nutritional predictors, are lacking. DESIGN AND SUBJECTS: We identified 1,113 twice-weekly and matched 4,448 thrice-weekly hemodialysis patients from a large national dialysis cohort of incident hemodialysis patients over 5 years (2007-2011). Mortality risk, adjusted for potential confounders, was examined across two-by-two combinations of serum creatinine (<6 vs. ≥6 mg/dL) and albumin (<3.5 g/dL vs. ≥3.5 g/dL) for each treatment frequency yielding a total of 8 groups. RESULTS:Patients were aged 70 ± 14 years and included 48% women and 55% diabetics. Using the thrice-weekly hemodialysis patients with creatinine ≥ 6 mg/dL and albumin ≥ 3.5 g/dL as reference, patients with creatinine <6 mg/dL and albumin <3.5 g/dL had a 1.8-fold higher risk of mortality (hazard ratio: 1.75, 95% confidence interval: 1.33-2.30) in twice-weekly and 2.2-fold increased risk of mortality (hazard ratio: 2.21, 95% confidence interval: 1.81-2.70) in thrice-weekly hemodialysis patients, respectively in fully adjusted models adjusted for demographics, comorbidities, and markers of malnutrition and inflammation. A test for interaction showed that there was no significant difference in albumincreatinine mortality associations between twice-weekly and thrice-weekly hemodialysis patients (P-for-interaction = .7667). CONCLUSIONS: Surrogate markers of higher visceral protein and muscle mass combined may confer greatest survival in both twice-weekly and thrice-weekly hemodialysis patients.
Authors: Kamyar Kalantar-Zadeh; Elani Streja; Csaba P Kovesdy; Antigone Oreopoulos; Nazanin Noori; Jennie Jing; Allen R Nissenson; Mahesh Krishnan; Joel D Kopple; Rajnish Mehrotra; Stefan D Anker Journal: Mayo Clin Proc Date: 2010-11 Impact factor: 7.616
Authors: Johanna T Dwyer; Brett Larive; June Leung; Michael V Rocco; Tom Greene; Jerrilynn Burrowes; Glenn M Chertow; David B Cockram; W Cameron Chumlea; John Daugirdas; Anne Frydrych; John W Kusek Journal: Kidney Int Date: 2005-10 Impact factor: 10.612
Authors: Nazanin Noori; Csaba P Kovesdy; Ramanath Dukkipati; Usama Feroze; Miklos Z Molnar; Rachelle Bross; Allen R Nissenson; Joel D Kopple; Keith C Norris; Kamyar Kalantar-Zadeh Journal: Am J Nephrol Date: 2011-02-04 Impact factor: 3.754
Authors: C Combe; P Chauveau; M Laville; D Fouque; R Azar; N Cano; B Canaud; H Roth; X Leverve; M Aparicio Journal: Am J Kidney Dis Date: 2001-01 Impact factor: 8.860
Authors: Jialin Wang; Elani Streja; Connie M Rhee; Melissa Soohoo; Mingliang Feng; Steven M Brunelli; Csaba P Kovesdy; Daniel Gillen; Kamyar Kalantar-Zadeh; Joline L T Chen Journal: J Ren Nutr Date: 2015-10-21 Impact factor: 3.655
Authors: Kamyar Kalantar-Zadeh; Joel D Kopple; Ryan D Kilpatrick; Charles J McAllister; Christian S Shinaberger; David W Gjertson; Sander Greenland Journal: Am J Kidney Dis Date: 2005-09 Impact factor: 8.860