Potential impact of nutritional intervention on end-stage renal disease hospitalization, death, and treatment costs

J Ren Nutr. 2007 Nov;17(6):363-71. doi: 10.1053/j.jrn.2007.08.009.


Objective: Our objective was to estimate the effect of an improvement in nutrition, represented by albumin concentrations, on hospitalization, mortality, and Medicare end-stage renal disease (ESRD) program cost.

Design: Based on published trials, the impact of an improvement in serum albumin of +0.2 g/dL from a hypothetical nutritional program for severely malnourished patients with albumin < or = 3.5 g/dL (base case) was estimated by reassigning patients to higher albumin categories, along with outcome risks associated with the new albumin category.

Setting: Data from Fresenius Medical Care North America (Waltham, MA) were utilized in regression models to determine the association between albumin and change in albumin concentration with outcomes.

Results: Albumin < or = 3.5 g/dL was associated with a > 2-fold increase in death and hospitalization risk, compared to > or = 4 g/dL (P < .001) in this population. An increase in albumin concentration was associated with a lower risk of death and hospitalization, whereas a declining albumin concentration led to worse outcomes. Projections for the United States dialysis population from the base case showed approximately 1400 lives saved, approximately 6000 hospitalizations averted, and approximately $36 million in Medicare cost savings resulting from a reduction of approximately 20,000 hospital days. A sensitivity analysis, varying the albumin response to +0.1 and +0.3 g/dL combined with varying albumin responder rates to 25% and 75% of patients, revealed robust results.

Conclusion: Nutritional interventions that increase serum albumin by > or = 0.2 g/dL (e.g., via oral nutritional supplements) may lead to considerable improvements in mortality, hospitalization, and treatment costs.

MeSH terms

  • Biomarkers / blood
  • Female
  • Health Care Costs*
  • Hospital Mortality*
  • Hospitalization
  • Humans
  • Kidney Failure, Chronic / mortality*
  • Kidney Failure, Chronic / therapy
  • Male
  • Medicare / economics*
  • Middle Aged
  • Nutritional Support / economics*
  • Nutritional Support / methods
  • Regression Analysis
  • Renal Dialysis* / economics
  • Renal Dialysis* / methods
  • Risk Assessment
  • Serum Albumin / analysis*
  • Treatment Outcome
  • United States


  • Biomarkers
  • Serum Albumin