TY - JOUR
T1 - Dynamics of Nutritional Competence in the Last Year Before Death in a Large Cohort of US Hemodialysis Patients
AU - Ye, Xiaoling
AU - Dekker, Marijke J. E.
AU - Maddux, Franklin W.
AU - Kotanko, Peter
AU - Konings, Constantijn J. A. M.
AU - Raimann, Jochen G.
AU - van der Sande, Frank M.
AU - Usvyat, Len A.
AU - Kooman, Jeroen P.
AU - Thijssen, Stephan
PY - 2017/11
Y1 - 2017/11
N2 - Objectives: Recently, a new Nutritional Competence Score (NCS) has been shown to associate with hospitalization and outcome in hemodialysis patients. The aim of this study was to investigate the dynamics, the individual components, and the impact of hospitalizations of this score's trajectory in the year before death. In addition, we investigated whether dynamics in the NCS add additional independent prognostic value over a single cross-sectional assessment.Design: We included all Fresenius Medical Care North America patients who initiated hemodialysis between January 1, 2006, and December 31, 2011 with data on all 5 NCS components (serum albumin, creatinine, phosphate, equilibrated normalized protein catabolic rate, and interdialytic weight gain) in at least 1 month. NCS was quantified monthly, and trajectories were compared between non-survivors and survivors across different dialysis vintage strata. Survivors and nonsurvivors were matched by dialysis vintage. The association of baseline NCS and NCS dynamics with mortality risk were assessed with Cox proportional hazards models.Results: In this cohort of 110,794 patients, we found that across all vintage groups, NCS was lower in patients who died than in survivors. NCS was found to significantly decline before death, whereas survivors showed no decline in NCS. The rate of NCS decline before death was not materially influenced by hospitalization in the months before death. Cox models showed that NCS dynamics over time carry significant predictive power above a cross-sectional NCS assessment.Conclusions: There are distinct differences in NCS values and their trajectories between patients who die and vintage-matched controls. These differences may be able to be exploited for implementation of a routine, prospective monitoring tool for early detection of patients at increased risk of death. Prospective studies are required to validate such an approach. (C) 2017 by the National Kidney Foundation, Inc. All rights reserved.
AB - Objectives: Recently, a new Nutritional Competence Score (NCS) has been shown to associate with hospitalization and outcome in hemodialysis patients. The aim of this study was to investigate the dynamics, the individual components, and the impact of hospitalizations of this score's trajectory in the year before death. In addition, we investigated whether dynamics in the NCS add additional independent prognostic value over a single cross-sectional assessment.Design: We included all Fresenius Medical Care North America patients who initiated hemodialysis between January 1, 2006, and December 31, 2011 with data on all 5 NCS components (serum albumin, creatinine, phosphate, equilibrated normalized protein catabolic rate, and interdialytic weight gain) in at least 1 month. NCS was quantified monthly, and trajectories were compared between non-survivors and survivors across different dialysis vintage strata. Survivors and nonsurvivors were matched by dialysis vintage. The association of baseline NCS and NCS dynamics with mortality risk were assessed with Cox proportional hazards models.Results: In this cohort of 110,794 patients, we found that across all vintage groups, NCS was lower in patients who died than in survivors. NCS was found to significantly decline before death, whereas survivors showed no decline in NCS. The rate of NCS decline before death was not materially influenced by hospitalization in the months before death. Cox models showed that NCS dynamics over time carry significant predictive power above a cross-sectional NCS assessment.Conclusions: There are distinct differences in NCS values and their trajectories between patients who die and vintage-matched controls. These differences may be able to be exploited for implementation of a routine, prospective monitoring tool for early detection of patients at increased risk of death. Prospective studies are required to validate such an approach. (C) 2017 by the National Kidney Foundation, Inc. All rights reserved.
KW - CHRONIC DIALYSIS PATIENTS
KW - SERUM-ALBUMIN
KW - MORTALITY
KW - INFLAMMATION
KW - PREDICTOR
U2 - 10.1053/j.jrn.2017.06.006
DO - 10.1053/j.jrn.2017.06.006
M3 - Article
C2 - 28943158
SN - 1051-2276
VL - 27
SP - 412
EP - 420
JO - Journal of Renal Nutrition
JF - Journal of Renal Nutrition
IS - 6
ER -