Xiaoling Ye1, Marijke J E Dekker2, Franklin W Maddux3, Peter Kotanko4, Constantijn J A M Konings5, Jochen G Raimann6, Frank M van der Sande2, Len A Usvyat3, Jeroen P Kooman2, Stephan Thijssen6. 1. Renal Research Institute, New York, New York. Electronic address: Xiaoling.Ye@rriny.com. 2. Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands. 3. Fresenius Medical Care North America, Waltham, Massachusetts. 4. Renal Research Institute, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York. 5. Department of Internal Medicine, Division of Nephrology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. 6. Renal Research Institute, New York, New York.
Abstract
OBJECTIVES: Recently, a new Nutritional Competence Score (NCS) has been shown to associate with hospitalization and outcome in hemodialysis patients. The aim of this study was to investigate the dynamics, the individual components, and the impact of hospitalizations of this score's trajectory in the year before death. In addition, we investigated whether dynamics in the NCS add additional independent prognostic value over a single cross-sectional assessment. DESIGN: We included all Fresenius Medical Care North America patients who initiated hemodialysis between January 1, 2006, and December 31, 2011 with data on all 5 NCS components (serum albumin, creatinine, phosphate, equilibrated normalized protein catabolic rate, and interdialytic weight gain) in at least 1 month. NCS was quantified monthly, and trajectories were compared between nonsurvivors and survivors across different dialysis vintage strata. Survivors and nonsurvivors were matched by dialysis vintage. The association of baseline NCS and NCS dynamics with mortality risk were assessed with Cox proportional hazards models. RESULTS: In this cohort of 110,794 patients, we found that across all vintage groups, NCS was lower in patients who died than in survivors. NCS was found to significantly decline before death, whereas survivors showed no decline in NCS. The rate of NCS decline before death was not materially influenced by hospitalization in the months before death. Cox models showed that NCS dynamics over time carry significant predictive power above a cross-sectional NCS assessment. CONCLUSIONS: There are distinct differences in NCS values and their trajectories between patients who die and vintage-matched controls. These differences may be able to be exploited for implementation of a routine, prospective monitoring tool for early detection of patients at increased risk of death. Prospective studies are required to validate such an approach.
OBJECTIVES: Recently, a new Nutritional Competence Score (NCS) has been shown to associate with hospitalization and outcome in hemodialysis patients. The aim of this study was to investigate the dynamics, the individual components, and the impact of hospitalizations of this score's trajectory in the year before death. In addition, we investigated whether dynamics in the NCS add additional independent prognostic value over a single cross-sectional assessment. DESIGN: We included all Fresenius Medical Care North America patients who initiated hemodialysis between January 1, 2006, and December 31, 2011 with data on all 5 NCS components (serum albumin, creatinine, phosphate, equilibrated normalized protein catabolic rate, and interdialytic weight gain) in at least 1 month. NCS was quantified monthly, and trajectories were compared between nonsurvivors and survivors across different dialysis vintage strata. Survivors and nonsurvivors were matched by dialysis vintage. The association of baseline NCS and NCS dynamics with mortality risk were assessed with Cox proportional hazards models. RESULTS: In this cohort of 110,794 patients, we found that across all vintage groups, NCS was lower in patients who died than in survivors. NCS was found to significantly decline before death, whereas survivors showed no decline in NCS. The rate of NCS decline before death was not materially influenced by hospitalization in the months before death. Cox models showed that NCS dynamics over time carry significant predictive power above a cross-sectional NCS assessment. CONCLUSIONS: There are distinct differences in NCS values and their trajectories between patients who die and vintage-matched controls. These differences may be able to be exploited for implementation of a routine, prospective monitoring tool for early detection of patients at increased risk of death. Prospective studies are required to validate such an approach.
Authors: Frank M van der Sande; Esther R van de Wal-Visscher; Stefano Stuard; Ulrich Moissl; Jeroen P Kooman Journal: Blood Purif Date: 2019-12-18 Impact factor: 2.614
Authors: Jeroen P Kooman; Len A Usvyat; Marijke J E Dekker; Dugan W Maddux; Jochen G Raimann; Frank M van der Sande; Xiaoling Ye; Yuedong Wang; Peter Kotanko Journal: Blood Purif Date: 2018-11-16 Impact factor: 2.614
Authors: Cristina Martins; Simone L Saeki; Marcelo Mazza do Nascimento; Fernando M Lucas Júnior; Ana Maria Vavruk; Christiane L Meireles; Sandra Justino; Denise Mafra; Estela Iraci Rabito; Maria Eliana Madalozzo Schieferdecker; Letícia Fuganti Campos; Denise P J van Aanholt; Ana Adélia Hordonho; Marcia Samia Pinheiro Fidelix Journal: J Bras Nefrol Date: 2021 Apr-Jun
Authors: Xiaoling Ye; Jeroen P Kooman; Frank M van der Sande; Jochen G Raimann; Len A Usvyat; Yuedong Wang; Franklin W Maddux; Peter Kotanko Journal: Clin Kidney J Date: 2019-12-05
Authors: Bernard Canaud; Xiaoling Ye; Len Usvyat; Jeroen Kooman; Frank van der Sande; Jochen Raimann; Yuedong Wang; Peter Kotanko Journal: Nephrol Dial Transplant Date: 2020-12-04 Impact factor: 5.992