Analysis of factors affecting the prognosis of a hemodialysis patient-Focusing on albumin and parameters of nutrition-

This study investigated differences in blood test results between surviving and non-surviving patients, the relationship between albumin (Alb) and other blood parameters, and improvements in the prognosis of hemodialysis (HD) patients, focusing on Alb as a nutritional parameter in HD patients. First, we calculated the average Alb value in 160 HD patients in 2005. Then we established a positive cohort using the preliminary result as mean (m-) Alb, and followed this cohort for 2 and a half years. During the follow-up period, we divided these patients to deceased and surviving patients, and analyzed the differences in m-blood urea nitrogen (BUN), m-phosphorus (P), m-normalized protein catabolic rate (nPCR), average age, and other factors. We also analyzed the relationship between m-Alb and other m-blood parameters. M-Alb of deceased patients was significantly lower than that of surviving patients (3.5 g/dL vs. 3.8 g/dL, p<0.0001). M-BUN (57.5 mg/dL vs. 67.8 mg/dL, p=0.0002), m-P (4.4 mg/dL vs. 4.9 mg/dL, p=0.0123), m-potassium (K) (4.4 mEq/L vs. 4.8 mEq/L, p=0.0018), and m-nPCR (0.9 g/kg/day vs. 1.1 g/kg/day, p=0.0011) of deceased patients were also significantly lower than those of surviving patients. The average age of deceased patients was significantly higher than that of surviving patients (71.5 years vs. 60.8 years, p=0.0008), and the HD history of deceased patients was longer than that of surviving patients, and the percentage of diabetic patients among deceased patients was greater than that among surviving patients, but the difference was not significant, and there was not a significant difference in the gender distribution between deceased and surviving patients. There were not significant differences in m-total protein (TP) or m-Kt/V between deceased and surviving patients. M-total cholesterol (TC) of deceased patients was lower than that of surviving patients, and m-C-reactive protein (CRP) of deceased patients was higher than that of surviving patients, but these differences were not significant. Moreover, there were positive significant correlation between m-Alb and m-BUN, m-P, m-K, m-TP, m-TC, and m-nPCR. And there was an inverse correlation between m-Alb and average age, and m-CRP. However, there was no correlation between m-Alb and HD history, and m-Kt/V. M-Alb of HD patients is a useful prognostic factor to predict survival. M-Alb m-BUN, m-P, and m-nPCR of deceased patients were all lower than those of surviving patients, suggesting that it is necessary to ensure sufficient intake of energy and protein to improve survival prognosis. Especially for elderly patients, it is necessary to ensure adequate intake and manage the rise in BUN and P prior to hemodialysis. When caring for elderly HD patients, it is necessary to change the concept of dietary restriction to the practice to appropriate intake of foods.