Patients receiving maintenance hemodialysis with low vs high levels of nutritional risk have decreased morbidity.

Objective: To compare the demographic and clinical characteristics and outcomes (morbidity) of 442 patients receiving maintenance hemodialysis who are at different levels of nutritional risk.

Design: A retrospective, longitudinal, chart review.

Setting/subjects: An urban, outpatient hemodialysis unit in New York City. Subjects were stratified according to their number of nutritional risk factors: zero to one=low risk, two to three=moderate risk, four to six=high risk.

Main Outcome Measures: Mean values for serum albumin <37 g/L, creatinine <884 micromol/L, total cholesterol <4.42 mmol/L, normalized protein nitrogen appearance <0.9 g/kg/day, weight change > -2.5 kg, and body mass index <24. Morbidity indicators were frequency and duration of hospitalizations.

Statistical Analyses: Descriptive statistics, analysis of variance, and chi 2 analysis were used to summarize data and to analyze mean differences between the groups and differences in categorical variables, respectively.

Results: Compared with the high-risk group, the majority of subjects in the low-risk group were younger, male, and did not have diabetes; fewer had two or more comorbidities. The high-risk group had 75% more hospitalizations and spent 195% more days in the hospital than the low-risk group.

Conclusions: Declining values of the nutritional risk factors and higher hospitalization rates were present in the high-risk group. Older subjects, those with diabetes, and those with two or more comorbidities comprised the majority of the high-risk group. More aggressive nutrition counseling and interventions may be needed for high-risk group members to determine if their risk for morbidity could be reduced.