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Murray DP, Young L, Waller J, Wright S, Colombo R, Baer S, Spearman V, Garcia-Torres R, Williams K, Kheda M, Nahman NS. Is Dietary Protein Intake Predictive of 1-Year Mortality in Dialysis Patients? Am J Med Sci 2018; 356:234-243. [PMID: 30286818 DOI: 10.1016/j.amjms.2018.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/26/2018] [Accepted: 06/08/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND High mortality in dialysis patients may be associated with protein-energy wasting (PEW) syndrome characterized by progressively depleted protein and energy stores. While early diagnosis and treatment of PEW can reduce mortality, clinically practical measures for its detection are lacking. Poor dietary protein intake (DPI) is associated with risk of malnutrition and PEW. However, the impact of DPI on mortality is unclear. The purpose of this study is to examine the ability of DPI to predict 1-year mortality in dialysis patients. METHODS This prospective, secondary study using data from the Comprehensive Dialysis Study and United States Renal Data System examined risk factors associated with 1-year mortality in dialysis patients. RESULTS Seventeen (7.5%) of the 227 subjects died within 1 year following baseline data collection. One year survivors were significantly younger (60 ± 13.6 versus 71 ± 12.8; P = 0.0043), had a lower Charlson Comorbidity Index score (1.6 ± 2.3 versus 4.0 ± 3.6; P = 0.0157), higher serum albumin level (3.5 ± 0.5 versus 3.3 ± 0.4; P = 0.0173) and had higher DPI (63 ± 33.7 versus 49.5 ± 21.5 g/day; P = 0.0386) than those who died. In multivariable Cox proportional hazards model analyses, only the Charlson Comorbidity Index adjusted hazard ratio for death (1.24) was significantly associated with increased mortality. The Comprehensive Dialysis Study data showed no association between DPI and 1-year mortality in dialysis patients. CONCLUSIONS Future studies using more precise measures should further examine the impact of DPI on mortality given the known association of DPI with PEW syndrome and the definitive link between PEW syndrome and survival in dialysis patients.
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Affiliation(s)
- David P Murray
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
| | - Lufei Young
- Department of Physiological and Technological Nursing, College of Nursing, Augusta University, Augusta, Georgia.
| | - Jennifer Waller
- Department of Population Health Sciences, Division of Biostatistics and Data Science, Medical College of Georgia at Augusta University, Augusta, Georgia.
| | - Stephanie Wright
- Department of Physiological and Technological Nursing, College of Nursing, Augusta University, Augusta, Georgia.
| | - Rhonda Colombo
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
| | - Stephanie Baer
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia; Charlie Norwood VA Medical Center, Augusta, Georgia.
| | - Vanessa Spearman
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
| | - Rosalia Garcia-Torres
- Department of Physiological and Technological Nursing, College of Nursing, Augusta University, Augusta, Georgia.
| | - Kori Williams
- Department of Physiological and Technological Nursing, College of Nursing, Augusta University, Augusta, Georgia.
| | - Mufaddal Kheda
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia; Southwest Georgia Nephrology Clinic, Albany, Georgia.
| | - N Stanley Nahman
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia; Charlie Norwood VA Medical Center, Augusta, Georgia.
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