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Longitudinal Associations among Renal Urea Clearance–Corrected Normalized Protein Catabolic Rate, Serum Albumin, and Mortality in Patients on Hemodialysis
- Source :
- Clinical Journal of the American Society of Nephrology. 12:1109-1117
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
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.
- 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
Subjects
Details
- ISSN :
- 1555905X and 15559041
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- Clinical Journal of the American Society of Nephrology
- Accession number :
- edsair.doi.dedup.....14287bf4d35e2dc3f48b99b16932a293