1. Longitudinal Associations among Renal Urea Clearance–Corrected Normalized Protein Catabolic Rate, Serum Albumin, and Mortality in Patients on Hemodialysis
- Author
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Csaba P. Kovesdy, Elani Streja, Amanda R. Tortorici, Connie M. Rhee, Rieko Eriguchi, Yoshitsugu Obi, Kamyar Kalantar-Zadeh, Melissa Soohoo, and Taehee Kim
- Subjects
Male ,Time Factors ,Epidemiology ,medicine.medical_treatment ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Kidney ,Critical Care and Intensive Care Medicine ,Gastroenterology ,Blood Urea Nitrogen ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Interquartile range ,Odds Ratio ,Urea ,Longitudinal Studies ,biology ,Middle Aged ,Treatment Outcome ,Nephrology ,Female ,Kidney Diseases ,Dietary Proteins ,Hemodialysis ,medicine.medical_specialty ,Serum albumin ,Serum Albumin, Human ,Models, Biological ,03 medical and health sciences ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Dialysis ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Transplantation ,Proportional hazards model ,business.industry ,Albumin ,Original Articles ,Odds ratio ,United States ,Renal Elimination ,Logistic Models ,Endocrinology ,chemistry ,biology.protein ,business ,Biomarkers - Abstract
Background and objectives There are inconsistent reports on the association of dietary protein intake with serum albumin and outcomes among patients on hemodialysis. Using a new normalized protein catabolic rate (nPCR) variable accounting for residual renal urea clearance, we hypothesized that higher baseline nPCR and rise in nPCR would be associated with higher serum albumin and better survival among incident hemodialysis patients. Design, setting, participants, & measurements Among 36,757 incident hemodialysis patients in a large United States dialysis organization, we examined baseline and change in renal urea clearance–corrected nPCR as a protein intake surrogate and modeled their associations with serum albumin and mortality over 5 years (1/2007–12/2011). Results Median nPCRs with and without accounting for renal urea clearance at baseline were 0.94 and 0.78 g/kg per day, respectively (median within-patient difference, 0.14 [interquartile range, 0.07–0.23] g/kg per day). During a median follow-up period of 1.4 years, 8481 deaths were observed. Baseline renal urea clearance–corrected nPCR was associated with higher serum albumin and lower mortality in the fully adjusted model (Ptrend Conclusions Among incident hemodialysis patients, higher dietary protein intake represented by nPCR and its changes over time appear to be associated with increased serum albumin levels and greater survival. nPCR may be underestimated when not accounting for renal urea clearance. Compared with the conventional nPCR, renal urea clearance–corrected nPCR may be a better marker of mortality.
- Published
- 2017