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Decreased dietary protein intake may be associated with increased mortality risk in individuals undergoing maintenance hemodialysis (MHD). We examined 8−year all-cause mortality in 100,088 MHD patients from DaVita dialysis clinics in the US (2001–2009) and hypothesized that survival is better across higher levels of nPNA, (nPCR, a dietary protein intake surrogate) with consistent trends across race and in hypoalbuminemic patients. Time-averaged Cox models were used to estimate death hazard ratios for quarterly averaged nPNA categories controlled for case-mix, comorbidity, dialysis dose, and available markers of malnutrition-inflammation-complex syndrome (MICS). In all patients, both low (

Low serum albumin level is the strongest mortality-predictor in maintenance hemodialysis (MHD) patients. It is not known whether this association is consistent across all age groups, especially in the elderly. We examined the association of serum albumin and all–cause mortality in 105,523 MHD patients across different age groups using Cox models to estimate death hazard ratios for quarterly averaged serum albumin increments controlled for case–mix, comorbidity, dialysis dose, and available markers of malnutrition–inflammation–complex syndrome (MICS) in all age groups. In those 4.0 g/dL continues to provide incremental survival advantage (Panel A), whereas in patients >65 yr old, no additional survival gain is observed beyond 4.0−g/dL (Panels B-D). High albumin levels are linearly associated with greater survival in all MHD patients although in the elderly gain stops at albumin >4.0 g/dL. Figure options Download full-size image Download as PowerPoint slide