Predictive value of dialysis adequacy and nutritional indices for mortality and morbidity in CAPD and HD patients. A longitudinal study

Background The effects of dialysis inadequacy on patient survival and nutritional status and that of malnutrition on survival have not been clearly assessed. Studies comparing dose/mortality and morbidity curves on continuous ambulatory peritoneal dialysis (CAPD) and on haemodialysis (HD) are also n...

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Veröffentlicht in:Nephrology, dialysis, transplantation dialysis, transplantation, 1995-12, Vol.10 (12), p.2295-2305
Hauptverfasser: Maiorca, R., Brunori, G., Zubani, R., Cancarini, G. C., Manili, L., Camerini, C., Movilli, E., Pola, A., d'Avolio, G., Gelatti, U.
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container_end_page 2305
container_issue 12
container_start_page 2295
container_title Nephrology, dialysis, transplantation
container_volume 10
creator Maiorca, R.
Brunori, G.
Zubani, R.
Cancarini, G. C.
Manili, L.
Camerini, C.
Movilli, E.
Pola, A.
d'Avolio, G.
Gelatti, U.
description Background The effects of dialysis inadequacy on patient survival and nutritional status and that of malnutrition on survival have not been clearly assessed. Studies comparing dose/mortality and morbidity curves on continuous ambulatory peritoneal dialysis (CAPD) and on haemodialysis (HD) are also needed, to assess adequate treatment on CAPD. Methods We have evaluated the effects of age, 13 pretreatment risk factors, serum albumin, transferrin, normalized protein catabolic rate, Kt/V, normalized weekly creatinine clearance, residual renal function and subjective global assessment of nutritional status on survival and morbidity, in a 3-year prospective study of 68 CAPD and 34 HD patients. Results Survivals did not differ for CAPD and HD patients. In the Cox hazard regression model, age, peripheral vasculopathy, serum albumin
doi_str_mv 10.1093/oxfordjournals.ndt.a091006
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A longitudinal study</title><source>Oxford University Press Journals Digital Archive Legacy</source><creator>Maiorca, R. ; Brunori, G. ; Zubani, R. ; Cancarini, G. C. ; Manili, L. ; Camerini, C. ; Movilli, E. ; Pola, A. ; d'Avolio, G. ; Gelatti, U.</creator><creatorcontrib>Maiorca, R. ; Brunori, G. ; Zubani, R. ; Cancarini, G. C. ; Manili, L. ; Camerini, C. ; Movilli, E. ; Pola, A. ; d'Avolio, G. ; Gelatti, U.</creatorcontrib><description><![CDATA[Background The effects of dialysis inadequacy on patient survival and nutritional status and that of malnutrition on survival have not been clearly assessed. Studies comparing dose/mortality and morbidity curves on continuous ambulatory peritoneal dialysis (CAPD) and on haemodialysis (HD) are also needed, to assess adequate treatment on CAPD. Methods We have evaluated the effects of age, 13 pretreatment risk factors, serum albumin, transferrin, normalized protein catabolic rate, Kt/V, normalized weekly creatinine clearance, residual renal function and subjective global assessment of nutritional status on survival and morbidity, in a 3-year prospective study of 68 CAPD and 34 HD patients. Results Survivals did not differ for CAPD and HD patients. In the Cox hazard regression model, age, peripheral vasculopathy, serum albumin <3.5 g/dl and Kt/V < 1.0/treatment on HD and <1.7/week on CAPD were independent factors negatively affecting survival. On the contrary, adjusted survivals were not affected by gender, modality, other comorbid factors, normalized protein catabolic rate, or subjective global assessment of nutritional status. Persistence of residual renal function significantly improved survival. Observed and adjusted survival did not significantly differ for CAPD and HD patients with either low (HD, <1.0/treatment; CAPD, < 1.7/week) or high (≥ 1.0 and ≥ 1.7) Kt/V. On HD, adjusted survivals were similar for 1.0≤ Kt/V < 1.2 or ≥ 1.2. On CAPD, Kt/V ≥ 1.96/week was associated with definitely better survival, with only one death/23 patients versus 19/45, with Kt/V ≤ 1.96. Survival was not different for 1.96 ≤ Kt/V < 2.03 and ≥ 2.03. Normalized weekly creatinine clearance and wKt/V were positively related on CAPD (r 0.39, P<0.01) and wKt/V=1.96 corresponded to 58 litres of normalized weekly creatinine clearance. Conclusion Indices of adequacy were predictors of mortality and morbidity, both on CAPD and HD, whereas normalized protein catabolic rate and subjective global assessment of nutritional status were not. Serum albumin did not decrease during dialysis; hence its predictive effect for survival is due to the predialysis condition and not to dialysis-induced malnutrition.]]></description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/oxfordjournals.ndt.a091006</identifier><language>eng</language><publisher>Oxford University Press</publisher><subject>adequacy ; CAPD ; haemodialysis ; nutrition ; patient survival ; peritoneal dialysis</subject><ispartof>Nephrology, dialysis, transplantation, 1995-12, Vol.10 (12), p.2295-2305</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids></links><search><creatorcontrib>Maiorca, R.</creatorcontrib><creatorcontrib>Brunori, G.</creatorcontrib><creatorcontrib>Zubani, R.</creatorcontrib><creatorcontrib>Cancarini, G. C.</creatorcontrib><creatorcontrib>Manili, L.</creatorcontrib><creatorcontrib>Camerini, C.</creatorcontrib><creatorcontrib>Movilli, E.</creatorcontrib><creatorcontrib>Pola, A.</creatorcontrib><creatorcontrib>d'Avolio, G.</creatorcontrib><creatorcontrib>Gelatti, U.</creatorcontrib><title>Predictive value of dialysis adequacy and nutritional indices for mortality and morbidity in CAPD and HD patients. A longitudinal study</title><title>Nephrology, dialysis, transplantation</title><description><![CDATA[Background The effects of dialysis inadequacy on patient survival and nutritional status and that of malnutrition on survival have not been clearly assessed. Studies comparing dose/mortality and morbidity curves on continuous ambulatory peritoneal dialysis (CAPD) and on haemodialysis (HD) are also needed, to assess adequate treatment on CAPD. Methods We have evaluated the effects of age, 13 pretreatment risk factors, serum albumin, transferrin, normalized protein catabolic rate, Kt/V, normalized weekly creatinine clearance, residual renal function and subjective global assessment of nutritional status on survival and morbidity, in a 3-year prospective study of 68 CAPD and 34 HD patients. Results Survivals did not differ for CAPD and HD patients. In the Cox hazard regression model, age, peripheral vasculopathy, serum albumin <3.5 g/dl and Kt/V < 1.0/treatment on HD and <1.7/week on CAPD were independent factors negatively affecting survival. On the contrary, adjusted survivals were not affected by gender, modality, other comorbid factors, normalized protein catabolic rate, or subjective global assessment of nutritional status. Persistence of residual renal function significantly improved survival. Observed and adjusted survival did not significantly differ for CAPD and HD patients with either low (HD, <1.0/treatment; CAPD, < 1.7/week) or high (≥ 1.0 and ≥ 1.7) Kt/V. On HD, adjusted survivals were similar for 1.0≤ Kt/V < 1.2 or ≥ 1.2. On CAPD, Kt/V ≥ 1.96/week was associated with definitely better survival, with only one death/23 patients versus 19/45, with Kt/V ≤ 1.96. Survival was not different for 1.96 ≤ Kt/V < 2.03 and ≥ 2.03. Normalized weekly creatinine clearance and wKt/V were positively related on CAPD (r 0.39, P<0.01) and wKt/V=1.96 corresponded to 58 litres of normalized weekly creatinine clearance. Conclusion Indices of adequacy were predictors of mortality and morbidity, both on CAPD and HD, whereas normalized protein catabolic rate and subjective global assessment of nutritional status were not. Serum albumin did not decrease during dialysis; hence its predictive effect for survival is due to the predialysis condition and not to dialysis-induced malnutrition.]]></description><subject>adequacy</subject><subject>CAPD</subject><subject>haemodialysis</subject><subject>nutrition</subject><subject>patient survival</subject><subject>peritoneal dialysis</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><recordid>eNqVj01OwzAQhS0EEuHnDiP2CZOGJGRZtaAsECoIIcTGGmoHTUntYjtVcwKujQtcgNXMG33vPY0QFzlmOTbFpd111qmVHZyh3mdGhYywyRGrA5HkVxWmk-K6PBRJhPMUS2yOxYn3K0RsJnWdiK-F04qXgbcattQPGmwHiqkfPXsgpT8HWo5ARoEZguPANjYBm2jSHmI7rK0L1HP4paJ6Y7VXbGA2Xcx_ru0cNhRYm-AzmEJvzTuHQfE-y8dlPBNHXfxAn__NU5He3jzN2pR90Du5cbwmN0pyH7Kqi7qU7curfKyrpr2_e5YPxX_5b-BZZlg</recordid><startdate>199512</startdate><enddate>199512</enddate><creator>Maiorca, R.</creator><creator>Brunori, G.</creator><creator>Zubani, R.</creator><creator>Cancarini, G. C.</creator><creator>Manili, L.</creator><creator>Camerini, C.</creator><creator>Movilli, E.</creator><creator>Pola, A.</creator><creator>d'Avolio, G.</creator><creator>Gelatti, U.</creator><general>Oxford University Press</general><scope>BSCLL</scope></search><sort><creationdate>199512</creationdate><title>Predictive value of dialysis adequacy and nutritional indices for mortality and morbidity in CAPD and HD patients. A longitudinal study</title><author>Maiorca, R. ; Brunori, G. ; Zubani, R. ; Cancarini, G. C. ; Manili, L. ; Camerini, C. ; Movilli, E. ; Pola, A. ; d'Avolio, G. ; Gelatti, U.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-istex_primary_ark_67375_HXZ_R769HNLV_Q3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>adequacy</topic><topic>CAPD</topic><topic>haemodialysis</topic><topic>nutrition</topic><topic>patient survival</topic><topic>peritoneal dialysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maiorca, R.</creatorcontrib><creatorcontrib>Brunori, G.</creatorcontrib><creatorcontrib>Zubani, R.</creatorcontrib><creatorcontrib>Cancarini, G. C.</creatorcontrib><creatorcontrib>Manili, L.</creatorcontrib><creatorcontrib>Camerini, C.</creatorcontrib><creatorcontrib>Movilli, E.</creatorcontrib><creatorcontrib>Pola, A.</creatorcontrib><creatorcontrib>d'Avolio, G.</creatorcontrib><creatorcontrib>Gelatti, U.</creatorcontrib><collection>Istex</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maiorca, R.</au><au>Brunori, G.</au><au>Zubani, R.</au><au>Cancarini, G. C.</au><au>Manili, L.</au><au>Camerini, C.</au><au>Movilli, E.</au><au>Pola, A.</au><au>d'Avolio, G.</au><au>Gelatti, U.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictive value of dialysis adequacy and nutritional indices for mortality and morbidity in CAPD and HD patients. A longitudinal study</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><date>1995-12</date><risdate>1995</risdate><volume>10</volume><issue>12</issue><spage>2295</spage><epage>2305</epage><pages>2295-2305</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><abstract><![CDATA[Background The effects of dialysis inadequacy on patient survival and nutritional status and that of malnutrition on survival have not been clearly assessed. Studies comparing dose/mortality and morbidity curves on continuous ambulatory peritoneal dialysis (CAPD) and on haemodialysis (HD) are also needed, to assess adequate treatment on CAPD. Methods We have evaluated the effects of age, 13 pretreatment risk factors, serum albumin, transferrin, normalized protein catabolic rate, Kt/V, normalized weekly creatinine clearance, residual renal function and subjective global assessment of nutritional status on survival and morbidity, in a 3-year prospective study of 68 CAPD and 34 HD patients. Results Survivals did not differ for CAPD and HD patients. In the Cox hazard regression model, age, peripheral vasculopathy, serum albumin <3.5 g/dl and Kt/V < 1.0/treatment on HD and <1.7/week on CAPD were independent factors negatively affecting survival. On the contrary, adjusted survivals were not affected by gender, modality, other comorbid factors, normalized protein catabolic rate, or subjective global assessment of nutritional status. Persistence of residual renal function significantly improved survival. Observed and adjusted survival did not significantly differ for CAPD and HD patients with either low (HD, <1.0/treatment; CAPD, < 1.7/week) or high (≥ 1.0 and ≥ 1.7) Kt/V. On HD, adjusted survivals were similar for 1.0≤ Kt/V < 1.2 or ≥ 1.2. On CAPD, Kt/V ≥ 1.96/week was associated with definitely better survival, with only one death/23 patients versus 19/45, with Kt/V ≤ 1.96. Survival was not different for 1.96 ≤ Kt/V < 2.03 and ≥ 2.03. Normalized weekly creatinine clearance and wKt/V were positively related on CAPD (r 0.39, P<0.01) and wKt/V=1.96 corresponded to 58 litres of normalized weekly creatinine clearance. Conclusion Indices of adequacy were predictors of mortality and morbidity, both on CAPD and HD, whereas normalized protein catabolic rate and subjective global assessment of nutritional status were not. Serum albumin did not decrease during dialysis; hence its predictive effect for survival is due to the predialysis condition and not to dialysis-induced malnutrition.]]></abstract><pub>Oxford University Press</pub><doi>10.1093/oxfordjournals.ndt.a091006</doi></addata></record>
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subjects adequacy
CAPD
haemodialysis
nutrition
patient survival
peritoneal dialysis
title Predictive value of dialysis adequacy and nutritional indices for mortality and morbidity in CAPD and HD patients. A longitudinal study
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