To determine the effect of renal function at the commencement of dialysis on nutritional state.
← Design
Retrospective cohort study.
← Setting
University tertiary referral hospital.
← Patients
Patients with end-stage renal disease commencing renal replacement therapy over 8.5 years.
← Main Outcome Measures
Total body nitrogen assessment using in vivo neutron activation analysis, expressed as nitrogen index (NI = observed total body nitrogen/predicted total body nitrogen); serum albumin measurement and creatinine clearance estimation, using the Cockcroft– Gault equation, at the start of dialysis. “Early” start group = creatinine clearance > 10 mL/minute (n = 26). “Late” start group = creatinine clearance ≤ 10 mL/min (n = 108).
← Results
Mean NI was significantly lower [95% confidence interval (CI) 6% – 30%, p < 0.0001] in the late start group (NI = 88%) compared to the early start group (NI = 106%). The late start group also had a significantly lower (95% CI 0.06 – 0.47 g/dL, p = 0.02) mean serum albumin level (3.66 g/dL) compared to that of the early start group (3.93 g/dL)A. positive independent correlation existed between renal function and total body nitrogen (r2 = 0.21, p < 0.0001). No other clinical or demographic variable at the start of dialysis was found to predict nutritional state.
← Conclusions
Patients that start dialysis with low levels of renal function are likely to be significantly malnourished. Whether this translates into a survival advantage requires prospective study.
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