Original investigation
Effects of increasing dialysis dose on serum albumin and mortality in hemodialysis patients

https://doi.org/10.1016/S0272-6386(96)90361-3Get rights and content

Abstract

Dialysis dose and malnutrition have a great impact on the clinical outcome of chronic hemodialysis patients. The interrelationships between them, however, remain undefined. Thus, we performed a study to determine the effects of increasing the dialysis dose on serum albumin concentrations and mortality in hemodialysis patients. We examined urea kinetic modeling, biochemical nutritional indices, comorbid conditions, patient survival time, and annual mortality rate. Dialysis dose, measured by Kt/V, significantly increased from 1.3 ± 0.3 in 1987 to 1.5 ± 0.4 in 1990 and to 1.7 ± 0.4 in 1993. Serum albumin level also increased, from 3.8 ± 0.4 g/dL in 1987 to 4.0 ±0.4 g/dL in 1990 and to 4.3 ± 0.3 g/dL in 1993. In 1993, 76% of patients had Kt/V ≥1.50 compared with 45% in 1990 and 28% in 1987, whereas 82% of patients had a serum albumin level ≥4.0 g/dL in 1993 compared with 58% in 1990 and 29% in 1987. Protein catabolic rate and hematocrit also increased from 1987 to 1993, but not serum cholesterol or triglyceride. The annual mortality rate decline from 16.1% in 1987 to 13.2% in 1990 and to 8.0% in 1993. The decrease in mortality appeared to be unrelated to differences in patient selection or comorbid conditions. Serum albumin levels, hematocrit, Kt/V, and protein catabolic rate were significantly related to patient survival after age, sex, and diabetic status had been adjusted. Furthermore, there was a positive correlation between Kt/Vs and serum albumin concentrations (r = 0.216, P <0.001). Thus, it appears that increasing the dose of dialysis improves serum albumin levels and perhaps survival rate in hemodialysis patients as well.

References (35)

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