Qureshi AR, Anderstam B, Danielsson A, Gutierrez A, Lindholm
B, Bergstrom J
Predictors of malnutrition in maintenance hemodialysis
patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Nov) 6:586 1995
Only 36% of 128 ESRD patients maintained with HD had normal nutritional
parameters by subjective global assessment and 13% had moderate to severe
protein-energy malnutrition. Those with severe malnutrition by subjective
assessment also had reduced body mass index, skinfold thickness, arm
circumference, serum albumin, and nPCR. Serum albumin as well as plasma
amino acid levels correlated with the nutritional status. However, serum
albumin also correlated equally well, although negatively, with serum levels
of C-reactive protein suggesting that inflammation or tissue injury was
equally if not more responsible for low serum albumin levels in many
patients.
Comment: This cross sectional study supplements the
longitudinal study by
the same investigators (218/573) that showed a correlation between
C-reactive protein and survival. Low serum albumin levels correlate with
impending death but the correlation may be nonspecific. Many serious disease
states (with the exception of uremia) cause an acute phase response by the
liver, lowering the serum albumin and raising levels of acute phase
reactants such as C-reactive protein, serum amyloid A, and fibrinogen. It
remains possible, however that an inflammatory or "acute phase" response to
some component of the dialysis itself may contribute to morbidity.
(Depner)
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Am Soc Nephrol
CRF by organ system :
Nutrition