A novel complex model of hemodialysis adequacy: predictive value and relationship with malnutrition-inflammation score
Keywords:
adequacy, hemodialysis, malnutrition-inflammation, model, scoreAbstract
Target dialysis dose to ensure the best patient outcome is still a matter of debate. Traditional models have a number of limitations and do not comprehensively reflect all factors involved. In this study we present a new complex model of dialysis adequacy, the hemodialysis adequacy score (HAS), and evaluate its prognostic value, as well as its relationship with the malnutrition-inflammation score (MIS). The components of HAS included paradigms of the 6 major factors known to influence the outcome of hemodialysis (HD) patients: the modified Karnofsky index (KI), the Charlson comorbidity index (CCI), Kt/V and URR measures of dialysis dose, body mass index (BMI) and serum albumin level, serum levels of hemoglobin and ferritin, intact parathyroid hormone (iPTH) and calcium-phosphorus solubility product. The score was evaluated in a 24-month prospective study on 147 HD patients. Odds ratio analysis showed that hospitalized patients had twice the chance to have HAS >13 compared to those who were not hospitalized during the study period (OR=2.152, CI 95% (1.0024-4.619). Mortality rate was significantly higher in patients with a HAS >13 at the 12-month follow-up (χ2=16.416, p <0.0001). Patients with a HAS≤13 had significantly higher survival rate (Kaplan-Meier), while those with a HAS>13 had significantly higher probability of death (log-rank Cox-Mantel=17.920, df=1, p <0.00023). The HAS directly and significantly correlated with the MIS at all measurements (p <0.0001). Results confirmed that the HAS is a useful tool to assess dialysis adequacy with a good prognostic value. The cutoff level for the HAS at 13 points was associated with an unfavorable outcome.
Received: February 29, 2016; Revised: March 12, 2016; Accepted: March, 13, 2016; Published online: October 10, 2016
How to cite this article: Vlatković V, Trbojević-Stanković J, Nešić D, Stojimirović B. A novel complex model of hemodialysis adequacy: predictive value and relationship with malnutrition-inflammation score. Arch Biol Sci. 2017;69(1):129-37.
Downloads
References
Nissenson AR. Improving outcomes for ESRD patients: shifting the quality paradigm. Clin J Am Soc Nephrol. 2014;9(2):430-4.
Mehta A. N, Fenves A. Z. Hemodialysis adequacy: A review. Dialysis Transplant. 2010;39(1):1-3.
Rayner HC, Pisoni RL, Bommer J, Canaud B, Hecking E, Locatelli F, Piera L, Bragg-Gresham JL, Feldman HI, Goodkin DA, Gillespie B, Wolfe RA, Held PJ, Port FK. Mortality and hospitalization in haemodialysis patients in five European countries: results from the dialysis outcomes and practice patterns study (DOPPS). Nephrol Dial Transplant. 2004;19: 108-20.
Pecoits-Filho R, Lindholm B, Stenvinkel P. The malnutrition, inflammation, and atherosclerosis (MIA) syndrome – the heart of the matter. Nephrol Dial Transplant. 2002;17(Suppl 11):28-31.
Grangé S, Hanoy M, Le Roy F, Guerrot D, Godin M. Monitoring of hemodialysis quality-of-care indicators: why is it important? BMC Nephrol. 2013;14:109.
Choi MJ, Seo JW, Yoon JW, Lee SK, Kim SJ, Lee YK, Noh JW, Koo JR. The malnutrition-inflammation-depression-arteriosclerosis complex is associated with an increased risk of cardiovascular disease and all-cause death in chronic hemodialysis patients. Nephron Clin Pract. 2012;122(1-2):44-52.
Crooks, V, Waller S, Smith T, Hahn TJ. The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. J Gerontol. 1991;46:M139-M144.
Di Iorio B, Cillo N, Cirillo M, De Santo NG. Charlson comorbidity index is a predictor of outcomes in incident hemodialysis patients and correlates with phase angle and hospitalization. Int J Artif Organs. 2004;27(4):330-6.
Uhlin F, Fridolin I, Magnusson M, Lindberg L-G. Dialysis dose (Kt/V) and clearance variation sensitivity using measurement of ultraviolet-absorbance (on-line), blood urea, dialysate and ionic dialysance. Nephrol Dial Transplant. 2006;2:2225-31.
Locatelli F, Covic A, Eckardt K-U, Wiecek A, Vanholder R. Anaemia management in patients with chronic kidney disease: a position statement by the Anaemia Working Group of European Renal Best Practice (ERBP). Nephrol Dial.Transplant. 2009;24(2):348-54.
Goldsmith DJ, Covic A, Fouque D, Locatelli F, Olgaard K, Rodriguez M, Spasovski G, Urena P, Zoccali C, London GM, Vanholder R. Endorsement of the Kidney Disease Improving Global Outcomes (KDIGO) Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guidelines: a European Renal Best Practice (ERBP) commentary statement. Nephrol Dial Transplant. 2010;25(12):3823-31.
De Palma JR, Pittard JD. Body mass index and uremia (Part I). Dial Transplant 2002;31(5):342-50.
De Palma JR, Pittard JD. Body mass index and uremia (Part II). Dial Transplant 2002;31(6):420-32.
Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2001;38(6):1251-63.
de Francisco ALM, Stenvinkel P, Vaulont S. Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness. Nephrol Dial Transplant. 2009;2(Suppl 1):i18-i26.
Locatelli F, Pisoni RL, Combe C, Bommer J, Andreucci VE, Piera L, Greenwood R, Feldman HI, Port FK, Held PJ. Anaemia in haemodialysis patients of five European countries: association with morbidity and mortality in the dialysis outcomes and practice patterns study (DOPPS). Nephrol Dial Transplant. 2004;19:121-32.
Stojimirović B, Petrović D, Obrenović R. Left ventricular hypertrophy in patients on hemodialysis: importance of anemia. Med Pregl. 2007;60(Suppl 2):155-9.
Jean G, Chazot C, Charra B. Hyperphosphataemia and related mortality. Nephrol Dial Transplant. 2006;21:273-80.
Shang D, Xie Q, Ge X, Yan H, Tian J, Kuang D, Hao CM, Zhu T. Hyperphosphatemia as an independent risk factor for coronary artery calcification progression in peritoneal dialysis patients. BMC Nephrol. 2015;16:107.
van Manen JG, van Dijk PCW, Stel VS, Dekker FW, Cleries M, Conte F, Feest T, Kramar R, Leivestad T, Briggs JD, Stengel B, Jager KJ. Confounding effect of comorbidity in survival studies in patients on renal replacement therapy. Nephrol Dial Transplant. 2007;22:187-95.
Trbojević J, Odović J, Stanković J, Nešić D, Jelić R. Relationship between angiotensin II receptor antagonists bio availability and molecular properties. Arch Biol Sci. 2016;68(2):273-8.
Caravaca F, Martin MV, Barroso S, Ruiz Belen, Hernández-Gallego R. Do inflammatory markers add predictive information of death beyond that provided by age and comorbidity in chronic renal failure patients? Nephrol Dial Transplant. 2006;21:1575-81.
Calo LA, Naso A, Carraro G, Wratten ML, Pagnin E, Bartipaglia L, Rebeschini M, Davis PA, Piccoli A, Cascone C. Effect of haemodiafiltration with online regeneration of ultrafiltrate on oxidative stress in dialysis patients. Nephrol Dial Transplant. 2007;22:1413-9.
Panichi V, Rizza GM, Paoletti S, Bigazzi R, Aloisi M, Barsotti G, Rindi P, Donati G, Antonelli A, Panicucci E, Tripepi G, Tetta C, Palla R. Chronic inflammation and mortality in haemodialysis: effect of different renal replacement therapies. Result from the RISCAVID study. Nephrol Dial Transplant. 2008;23:2337-43.
Kalantar-Zadeh K, Ikizler TA. Let them eat during dialysis: an overlooked opportunity to improve outcomes in maintenance hemodialysis patients. J Ren Nutr 2013;23(3):157-63.
Trbojević-Stanković J, Odović J, Jelić R, Nešić D, Stojimirović B. The effect of calcium channel blockers’ molecular properties on elimination route. Arch Biol Sci. 2015; 67(3):801-6.
Lin YT, Wu PH, Kuo MC, Lin MY, Lee TC, Chiu YW, Hwang SJ, Chen HC. High cost and low survival rate in high comorbidity incident elderly hemodialysis patients. PLoS One. 2013;8(9):e75318.
Ritchie JP, Alderson H, Green D, Chiu D, Sinha S, Middleton R, O'Donoghue D, Kalra PA. Functional status and mortality in chronic kidney disease: results from a prospective observational study. Nephron Clin Pract. 2014;128(1-2):22-8.
Petrović D, Stojimirović B. Cardiovascular morbidity and mortality in patients treated with hemodialysis-epidemiological analysis. Vojnosanit Pregl. 2008;65(12):893-900.
Di Iorio B, Cillo N, Cirillo M, De Santo NG. Charlson comorbidity index is a predictor of outcomes in incident hemodialysis patients and correlates with phase angle and hospitalization. Int J Artif Organs 2004; 27(4):330-6.
van Diepen M, Schroijen MA, Dekkers OM, Rotmans JI, Krediet RT, Boeschoten EW, Dekker FW. Predicting mortality in patients with diabetes starting dialysis. PLoS One. 2014;9(3):e89744.
Vlatković V, Stojimirović B. Determination of the delivered hemodialysis dose using standard methods and on-line clearance monitoring].Vojnosanit Pregl. 2006;63(8):743-7.
Vlatkovic V, Trbojevic-Stankovic J, Stojimirovic B. Malnutrition-inflammation complex syndrome and hepatitis C in maintenance hemodialysis patients. Ther Apher Dial. 2009;13(2):113-20.
Spiegel DM, Raggi P, Smits G, Block GA. Factors associated with mortality in patients new to haemodialysis. Nephrol Dial Transplant 2007;22:3568-72.
Beddhu S, Pappas LM, Ramkumar N, Samore MH. Malnutrition and atherosclerosis in dialysis patients. J Am Soc Nephrol 2004;15:733-42.
Anand N, Chandrasekaran SC, Alam MN. The Malnutrition Inflammation Complex Syndrome-The Micsing Factor in the Perio-Chronic Kidney Disease Interlink. J Clin Diagn Res. 2013;7(4):763-7.
Jung MY, Hwang SY, Hong YA, Oh SY, Seo JH, Lee YM, Park SW, Kim JS, Wang JK, Kim JY, Lee JE, Ko GJ, Pyo HJ, Kwon YJ. Optimal hemoglobin level for anemia treatment in a cohort of hemodialysis patients. Kidney Res Clin Pract 2015;34(1):20-7.
Di Lullo L, Gorini A, Russo D, Santoboni A, Ronco C. Left Ventricular Hypertrophy in Chronic Kidney Disease Patients: From Pathophysiology to Treatment. Cardiorenal Med. 2015;5(4):254-66.
Madore F, Lowrie EG, Brugnara C, Lew NL, Lazarus JM, Bridges K, Owen WF. Anemia in hemodialysis patients: variables affecting this outcome predictor. J Am Soc Nephrol. 1997;8(12):1921-9.
Kalantar-Zadeh K, Rodriguez RA, Humphreys MH. Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients. Nephrol Dial Transplant. 2004;19(1):141-9.
Ketteler M, Floege J. Calcification and the usual suspect phosphate: still guilty but there are other guys behind the scenes. Nephrol Dial Transplant 2006;21:33-5.
Baber U, de Lemos JA, Khera A, McGuire DK, Omland T, Toto RD, Hedayati SS. Non-traditional risk factors predict coronary calcification in chronic kidney disease in a population-based cohort. Kidney Int 2008;73:615-21.
Downloads
Published
How to Cite
Issue
Section
License
Authors grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.
