Patients with poor or declining nutritional status during dialysis initiation are at increased risks for death, a new study finds.

Investigators calculated an Integrative Clinical Nutrition Dialysis Score (ICNDS) for 297 patients at dialysis initiation and 1, 2, and 3 months later. For each patient, they ranked 7 parameters – serum albumin, creatinine, and urea, cholesterol, dialysis adequacy, C-reactive protein (CRP), and post-dialysis weight change – on a scale from 1 (abnormal) to 5 (meets guideline recommendations) and tallied the score. Weight change and albumin levels each accounted for 25% of the ICNDS, and the remaining 5 parameters each made up 10%. A low ICNDS was less than 75 and a high ICNDS 75 or more.

Patients with a low vs high ICNDS at baseline had 2.5- and 1.5-fold increased odds of all-cause death at 1 and 5 years, respectively, Sara Blumberg Benyamini, PhD, of Wolfson Medical Center in Holon, Israel, and colleagues reported in the Journal of Renal Nutrition. Deterioration of nutritional status within the first 3 months of dialysis (indicated by a negative vs positive ICNDS slope) was significantly associated with 1.7-fold increased odds of mortality within 3 years – even among those with favorable nutritional status at baseline.

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Patients with a low ICNDS at dialysis initiation were significantly older and had a higher prevalence of diabetes, cardiovascular disease, and malignancy. They also had higher CRP levels. According to the investigators, protein-energy wasting (PEW) and inflammation, together known as malnutrition-inflammation complex syndrome, likely explains the differences between the low and high ICNDS groups.

“The results of our research call for special attention for pre-dialysis care,” Dr Benyamini’s team wrote. “We suggest a multidisciplinary approach that includes attention to diet and provision of adequate treatment for comorbidities in the period before initiation of dialysis, with the aim of increasing the ICNDS during the transition to [renal replacement therapy]. This then might improve survival odds after dialysis initiation.”


Blumberg Benyamini S, Barnea Z, Cernes R, et al. Association of nutrition status at dialysis start with long-term survival: A 10-year retrospective study. J Ren Nutr. Published online January 25, 2022. doi:10.1053/j.jrn.2022.01.001