Abstract 1401: Malnutrition and Chronic Inflammation Status at Initiating Phase of Hemodialysis Can Stratify the Risk of Cardiovascular and All-cause Mortality in End Stage Renal Disease Patients - 10 Years Follow-up Study
Background: It has been established that both malnutrition and chronic inflammation are associated with future cardiovascular (CV) events in patients with end-stage renal disease (ESRD). Low body mass index (BMI) has been also associated with poor survival in this population, which is known as “obesity paradox”. We examined a prognostic value of combining serum albumin, serum C-reactive protein (CRP) levels and BMI for CV and all-cause mortality in ESRD patients from initial phase of hemodialysis (HD) therapy.
Methods: Consecutive 1,228 ESRD patients (male 65%, age 60±14years, diabetes 44%) were enrolled at starting point of HD therapy. The cut-off levels of serum albumin, serum CRP and BMI were determined using receiver operating characteristic analysis (AUC=0.63, 0.67 and 0.62, respectively), therefore serum albumin <3.5g/dl, serum CRP > 0.40mg/dl and BMI <19.6Kg/m2 were defined as risk factors, respectively. Thereafter, the patients were divided into groups according to the number of risk factors; patients without any factors (group 0, n=314), with one factor (group 1, n=409), with two factors (group 2, n=385) and with all factors (group 3, n=120), respectively, and were followed up for 10 years.
Results: During follow-up period (50±35months), 295 patients (24.0%) died including 139 CV death (11.3%). On Kaplan-Meier analysis, 10-year CV mortality were 18.8%, 21.0%, 27.5% and 47.8% in the group 0, 1, 2 and 3 (p<0.0001), respectively. All-cause mortality were also 14.5%, 34.0%, 57.2% and 78.3% in the same order of the groups (p<0.0001), respectively. After adjustment for traditional risk factors, hazard ratio (HR) for both mortalities significantly increased according to the number of risk factors increased (Table⇓).
Conclusion: These data suggest that combining declined serum albumin, elevated CRP levels and lower BMI at the beginning of HD could strongly predict the risk of future CV and all-cause mortality in ESRD patients.