Dietary intake as a predictor for all-cause mortality in hemodialysis subjects (NUGE-HD study)

PLoS One. 2019 Dec 17;14(12):e0226568. doi: 10.1371/journal.pone.0226568. eCollection 2019.

Abstract

This study aimed to identify the factors capable of mortality prediction in patients on hemodialysis, using a prospective cohort with three years of follow-up. We hypothesized that lack of clinical-metabolic control, impairment of nutritional status, and inadequate food consumption are risk factors for mortality in this population. This is a longitudinal study on a non-probabilistic sample of 85 adults and elderly patients undergoing hemodialysis, aged ≥ 18 years (66.0% male, 61.6±13.7 years). Data on anthropometric, biomarkers, body composition and food intake were obtained. Predictors of mortality were evaluated using Cox regression analysis. During the three years follow-up, 16 patients (18.8%) died. We observed that age (HR = 1.319, CI 95% = 1.131-1.538), calcium-phosphorus product (HR = 1.114, CI 95% = 1.031-1.205), ferritin (HR = 1.001, CI 95% = 1.001-1.002), nitric oxide (HR = 1.082, CI 95% = 1.006-1.164), and vitamin C intake (HR = 1.005, CI 95% = 1.001-1.009) were positively associated with mortality. Serum iron (HR = 0.717, CI 95% = 0.567-0.907), triceps skinfold thickness (HR = 0.704, CI 95% = 0.519-0.954), lean mass (HR = 0.863, CI 95% = 0.787-0.945), and the ratio of dietary monounsaturated/polyunsaturated fat (HR = 0.022, CI 95% = 0.001-0.549) were independent negative predictors of mortality. Our results suggest that dietary intake is also a predictor of mortality in patients on hemodialysis, besides nutritional status, body composition, oxidative stress, inflammation, and bone metabolism, indicating the importance of evaluation of these factors altogether for better prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / metabolism
  • Body Composition
  • Cohort Studies
  • Diet*
  • Eating
  • Female
  • Humans
  • Kidney Failure, Chronic / metabolism
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Mortality*
  • Nutritional Status
  • Proportional Hazards Models
  • Renal Dialysis*
  • Young Adult

Substances

  • Biomarkers

Grants and funding

This study was financed by the Coordination of Improvement of Higher Level Personnel – CAPES (Ministry of Education, Finance Code 001), the National Council for Scientific and Technological Development – CNPq (Ministry of Science, Technology and Innovation, Brazil) and Foundation for Research Support of the State of Minas Gerais - FAPEMIG (State of Minas Gerais, Brazil). HHMH and JB are CNPq fellows in Research Productivity. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.