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      The Normalized Treatment Ratio (Kt/V) Is Not the Best Dialysis Dose Parameter

      Blood Purification

      S. Karger AG

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          Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients.

          Body mass index (BMI) at its extremes contributes to morbidity and mortality in the general population. Its influence on morbidity and mortality in patients on hemodialysis is not clearly defined. The BMI in 1346 patients attending limited-care hemodialysis units across the state of Mississippi was determined, and its relation to one-year mortality and hospital stay was assessed using the Cox proportional hazard model. Of these patients, 89% were black, and 11% were white. Thirty-eight percent of patients were overweight (BMI > 27.5), and 13% were underweight (BMI < 20). The highest (27.60 +/- 0.29, mean +/- SE) and the lowest (24.54 +/- 0.48) BMI were noted in black females and white males, respectively. BMI, race, hematocrit (Hct), and biochemical markers of better nutrition positively influenced the survival, whereas age, serum globulin, and diabetes had a negative influence. In a Cox multivariate analysis, BMI, age, diabetes, prealbumin, and creatinine, but not race, serum albumin, Hct, or serum globulin, retained significant influence on survival. Compared with the normal weight (BMI between 20 and 27.5), the one-year survival rate was significantly higher in the overweight patients and lower in the underweight patients. With a one-unit increase in BMI over 27.5, the relative risk for dying was reduced by 30% (P < 0.04), and with a one-unit decrease in BMI below 20, the relative risk was increased by 1.6-fold (P < 0.01). Furthermore, underweight patients had significantly lower levels of biochemical markers of nutrition and higher frequency and longer duration of hospital stay. Adequate dialysis with special attention to proper nutrition aimed to achieve the high end of normal BMI may help to reduce the high mortality and morbidity in hemodialysis patients.
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            Dose of Hemodialysis and Survival


              Author and article information

              Blood Purif
              Blood Purification
              S. Karger AG
              18 August 2000
              : 18
              : 4
              : 286-294
              Duke Clinical Research Institute, Duke University Medical School, Durham, N.C., and Fresenius Medical Care (NA), Lexington, Mass., USA
              14450 Blood Purif 2000;18:286–294
              © 2000 S. Karger AG, Basel

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              Page count
              Figures: 7, Tables: 1, References: 25, Pages: 9
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/14450

              Cardiovascular Medicine, Nephrology


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