Nutritional parameters and mortality in incident hemodialysis patients

J Ren Nutr. 2006 Jan;16(1):27-35. doi: 10.1053/j.jrn.2005.10.003.


Objective: To evaluate the impact of nutritional parameters at the time of initiation of hemodialysis (HD) on mortality.

Design: Retrospective study.

Setting: Dialysis Unit of the Federal University of Sao Paulo, Oswaldo Ramos Foundation.

Patients: Three hundred forty-four incident HD patients (60.5% male, 26% diabetic) with the first nutritional evaluation performed before completing 3 months of onset of HD were included.

Methods: The study consisted of baseline measurements of several nutritional parameters (triceps skinfold thickness [TSF], midarm muscle circumference [MAMC], body mass index [BMI], serum albumin, serum creatinine, and protein and energy intake assessed by 3-day food diary) and records of outcome (death) over a period of 10 years.

Results: Muscle and/or fat depletion was observed in 51% of the studied patients, according to the percent standard of MAMC and TSF, respectively. Presence of diabetes, age over 60 years, serum albumin < 3.5 g/dL, MAMC adequacy < 90%, protein intake < 1.0 g/kg/d, and energy intake < 25 kcal/kg/d were associated with worse survival. When patients were analyzed according to tertiles of dialysis vintage, BMI > or = 25 (calculated as kg/m2) had a negative impact on survival only in the highest tertile (> 2.45 years). Patients with BMI < 25 and MAMC adequacy > or = 90% showed the best survival over the study period, and those with BMI > or = 25 but MAMC adequacy < 90% had the worst survival (P = .004). In the multivariate survival analysis adjusting for diabetes, advanced age, and hypoalbuminemia, the reduced MAMC (P = .008) and the low energy intake (P = .03) were independent predictors of death in incident HD patients.

Conclusions: Reduced MAMC and low energy intake at the beginning of chronic dialysis are risk factors for mortality. A negative effect of high BMI on survival was associated with reduced MAMC and longer dialysis vintage.

MeSH terms

  • Adipose Tissue
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anthropometry
  • Arm / anatomy & histology
  • Body Composition
  • Body Mass Index
  • Creatinine / blood
  • Dietary Proteins / administration & dosage
  • Energy Intake
  • Female
  • Humans
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Muscle, Skeletal / anatomy & histology
  • Nutritional Status*
  • Proportional Hazards Models
  • Renal Dialysis / mortality*
  • Retrospective Studies
  • Serum Albumin / analysis
  • Sex Characteristics
  • Skinfold Thickness
  • Survival Rate
  • Time Factors


  • Dietary Proteins
  • Serum Albumin
  • Creatinine