The relationship of nutrition status and dietary intake with hospitalization and mortality in hemodialysis patients; a single-center observational cohort study

Abstract

Introduction: No single nutrition parameter can accurately assess nutritional status, to predict outcomes and to drive the priorities for nutrition care in patients undergoing hemodialysis (HD). Objectives: The aim of this study was to assess the nutritional status of HD patients using two validated assessment tools; the "7-point subjective global assessment" (SGA) and "malnutrition inflammation score" (MIS); to determine participants’ daily energy intakes (DEI) and daily protein intakes (DPI); and also to examine the relationship of these parameters with hospitalization and mortality. Patients and Methods: This is a 12-month prospective, single HD-center study that recruited 77 HD participants from an outpatient center in South Florida. For the purpose of this analysis, participants with SGA ≤ 5 and MIS > 7 and were considered to have an inadequate nutritional status represented by SGA-I and MIS-I, respectively. Inadequate energy (DEI-I) and inadequate protein (DPI-I) intake were defined using cutoff values. The outcomes and endpoints of this study were hospitalizations and mortality, registered over 12 months. Results: Fifty-five male and 22 female patients from a single HD center participated in the study. During the 12-month study, 63.6% of participants were hospitalized, 7% transplanted and 13% died. The group of participants with an inadequate nutritional status (defined as SGA-I and MIS-I) and inadequate energy intake (defined as DEI-I) had an increased hazard ratio for mortality [SGA-I and DEI-I [HR: 7.18 (95% CI: 1.18-43.43; P= 0.032] and [MIS-I and DEI-I [HR: 13.23, 95% CI: 2.1-83.2; P=0.006] and the likelihood of hospitalization increased almost 3-fold [HR: 2.73, 95% CI: 1.09-6.842; P=0.031], in the case of MIS-I. Conclusion: These results indicated that energy intake lower than 25 kcal/kg/day increases the risks of hospitalization and mortality for those HD patients with an impaired nutritional status.