Effect of Adequacy of Dialysis and Nutrition on Morbidity and Working Rehabilitation of Patients Treated by Maintenance Hemodialysis

Abstract

Numerous studies have demonstrated a correlation between adequacy of hemodialysis (HD) and patient mortality. In this study we evaluated the effect of adequacy of dialysis and nutrition on morbidity and working rehabilitation. Single center experience carried out in 1998 in an outpatient university-affiliated dialysis facility was presented. A total of 181 patients, on HD over 3 months, was included in the study; mean age 54.5 years, mean duration of HD 5.4 years. Thirthy-two patients were hospitalized in 1998. Patients with an eKt/V < 0.8 had significantly more frequent and extended hospitalizations than patients with eKt/V > 1.2. In the regression model eKt/V had a significant effect on hospital days. Serum albumin, as an index of nutrition, was also found to significantly influence hospitalizations. Patients with a BMI < 20.0 kg/m² were found to have significantly more frequent hospitalizations, more hospital days/patient, and hospital days/hospitalized patient/year than those with a BMI > 25.0 kg/m². BMI < 20.0 kg/m² was associated with a significantly lower dialysis adequacy (eKt/V and URR) and more severe anemia. However, regression model failed to confirm a statistically significant association of BMI with hospital days. The best working rehabilitation (stage 1), according to the EDTA criteria, was obtained in patients with significantly (p<0.05) higher eKt/V, URR, albumin, nPNA, and body fat than in patients at stage 6 (not able to work, and not able to take care of themselves).

This study has established that dialysis adequacy and nutrition have an effect on morbidity (estimated through hospitalizations) and patient rehabilitation. (Int J Artif Organs 2000; 23: 83–9)