Predialysis Dietitian Care May Improve Survival
Predialysis dietitian care for more than 12 months may be associated with better survival during the first year on hemodialysis (HD), researchers reported.
Yelena Slinin, MD, MS, of the Veterans Administration Medical Center and the University of Minnesota in Minneapolis, and colleagues studied 156,440 patients whose dietitian care status was known prior to starting HD. Of these, 88% received no dietitian care, 9% received dietitian care for 12 months or less, and 3% received dietitian care for more than 12 months before starting HD. Patients were followed up for 12 months from the first dialysis date. During a mean follow-up of 9.9 months, 38,687 patients (24.7%) died.
The researchers divided patients into tertiles of propensity score, which they calculated using patient characteristics and covariate interactions. Patients in the first tertile who received no dietitian care served as a reference group.
Compared with the reference group, patients in the second tertile who received more than 12 months of dietitian care had a significant 19% reduction in mortality risk, after adjusting for numerous potential confounders, according to a report in the American Journal of Kidney Diseases (published online ahead of print). The investigators observed no significant survival benefit among those in the third tertile who had received more than 12 months of dietitian care or in any of the patients who received less than 12 months of dietitian care.
“Dietitian care can influence patient outcomes by improving levels of biomarkers associated with morbidity and mortality in patients with kidney disease,” Dr. Slinin's group wrote. “We found that predialysis dietitian care was associated independently in a graded manner with a higher likelihood of normoalbuminuria at dialysis therapy initiation.” Hypoalbuminemia is strongly associated with mortality in HD patients, they added.