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Nutrition-related variables reflecti...

Burrowes, Jerrilynn Denise.

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Nutrition-related variables reflective of protein-energy malnutrition that predict morbidity and mortality in younger, middle-aged, and older adults receiving maintenance hemodialysis.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Nutrition-related variables reflective of protein-energy malnutrition that predict morbidity and mortality in younger, middle-aged, and older adults receiving maintenance hemodialysis./
Author:	Burrowes, Jerrilynn Denise.
Description:	185 p.
Notes:	Source: Dissertation Abstracts International, Volume: 63-03, Section: B, page: 1278.
Contained By:	Dissertation Abstracts International63-03B.
Subject:	Health Sciences, Nutrition. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3045703
ISBN:	0493596550

Nutrition-related variables reflective of protein-energy malnutrition that predict morbidity and mortality in younger, middle-aged, and older adults receiving maintenance hemodialysis.
Burrowes, Jerrilynn Denise.

Nutrition-related variables reflective of protein-energy malnutrition that predict morbidity and mortality in younger, middle-aged, and older adults receiving maintenance hemodialysis. - 185 p.

Source: Dissertation Abstracts International, Volume: 63-03, Section: B, page: 1278.

Thesis (Ph.D.)--New York University, 2002.

Background. Despite significant improvements in the delivery of dialysis therapy in the U.S., the morbidity and mortality rates of people receiving maintenance hemodialysis (MHD) remain high. Protein-energy malnutrition (PEM) is a major risk factor for poor outcome. Older people, the most rapidly growing subgroup of the MHD population today, are more susceptible to PEM than their younger counterparts. This study will identify the nutrition-related variables (NRV) (i.e., serum albumin [SA], serum creatinine [SCr], total serum cholesterol, normalized protein nitrogen appearance [nPNA], weight change, and body mass index [BMI]) that predict morbidity and mortality in younger (18 to 44), middle-aged (45 to 64), and older (65 to 92) adults receiving MHD. Methods. In this retrospective analysis, the NRV were obtained monthly for 442 MM patients. Frequency and duration of hospitalizations and mortality data were also obtained. Cox regression analysis was used to identify independent predictors of hospitalization and death. Results . Low SA was the strongest predictor of hospitalization and death in the study cohort. Declining SCr, weight loss, and diabetes were also strong predictors; age, sex, and comorbidity score were not. The NRV did not differ in predicting morbidity and mortality between the age groups. Older people had significantly lower SA and SCr, which suggests depleted visceral and somatic protein status, and significantly more hospital admissions and hospital days. Mean SA, SCr, and BMI were significantly lower in individuals who died. Participants who were hospitalized more frequently had significantly lower levels of SA, SCr, and nPNA, and lost more body weight. Conclusions. Despite their clinical utility, the NRV examined may be insensitive to changes in protein-energy nutritional status, and may be influenced by inflammation or infection. Further research is needed to determine whether interventions that promote better nutritional status (i.e., higher levels of SA, SCr, and weight maintenance or weight gain), while controlling for inflammation and infection, will improve survival in this cohort. Although no differences in the predictors of poor outcome were identified by age group, clinical experience justifies the need for more aggressive interventions in older people receiving MHD.

ISBN: 0493596550Subjects--Topical Terms:

1017801
Health Sciences, Nutrition.

Nutrition-related variables reflective of protein-energy malnutrition that predict morbidity and mortality in younger, middle-aged, and older adults receiving maintenance hemodialysis.
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500 $a Source: Dissertation Abstracts International, Volume: 63-03, Section: B, page: 1278.
500 $a Chair: Sharron Dalton.
502 $a Thesis (Ph.D.)--New York University, 2002.
520 $a Background. Despite significant improvements in the delivery of dialysis therapy in the U.S., the morbidity and mortality rates of people receiving maintenance hemodialysis (MHD) remain high. Protein-energy malnutrition (PEM) is a major risk factor for poor outcome. Older people, the most rapidly growing subgroup of the MHD population today, are more susceptible to PEM than their younger counterparts. This study will identify the nutrition-related variables (NRV) (i.e., serum albumin [SA], serum creatinine [SCr], total serum cholesterol, normalized protein nitrogen appearance [nPNA], weight change, and body mass index [BMI]) that predict morbidity and mortality in younger (18 to 44), middle-aged (45 to 64), and older (65 to 92) adults receiving MHD. Methods. In this retrospective analysis, the NRV were obtained monthly for 442 MM patients. Frequency and duration of hospitalizations and mortality data were also obtained. Cox regression analysis was used to identify independent predictors of hospitalization and death. Results . Low SA was the strongest predictor of hospitalization and death in the study cohort. Declining SCr, weight loss, and diabetes were also strong predictors; age, sex, and comorbidity score were not. The NRV did not differ in predicting morbidity and mortality between the age groups. Older people had significantly lower SA and SCr, which suggests depleted visceral and somatic protein status, and significantly more hospital admissions and hospital days. Mean SA, SCr, and BMI were significantly lower in individuals who died. Participants who were hospitalized more frequently had significantly lower levels of SA, SCr, and nPNA, and lost more body weight. Conclusions. Despite their clinical utility, the NRV examined may be insensitive to changes in protein-energy nutritional status, and may be influenced by inflammation or infection. Further research is needed to determine whether interventions that promote better nutritional status (i.e., higher levels of SA, SCr, and weight maintenance or weight gain), while controlling for inflammation and infection, will improve survival in this cohort. Although no differences in the predictors of poor outcome were identified by age group, clinical experience justifies the need for more aggressive interventions in older people receiving MHD.
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