Dietary Protein Intake and Survival in 100,088 Maintenance Hemodialysis Patients: The Role of Race and Albumin

• Published in: Kidney research and clinical practice Vol. 31; no. 2; p. A41
• Main Authors: Ravel, Vanessa, Molnar, Miklos Z, Jing, Jennie, Streja, Elani, Victoroff, Alla, Kovesdy, Csaba P, Norris, Keith C, Kopple, Joel D, Benner, Debbie, Chul Kim, Jun, Kalantar-Zadeh, Kamyar
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.06.2012; The Korean Society of Nephrology
• Subjects: Nephrology
• ISSN: 2211-9132
• DOI: 10.1016/j.krcp.2012.04.421

Decreased dietary protein intake may be associated with increased mortality risk in individuals undergoing maintenance hemodialysis (MHD). We examined 8−year all-cause mortality in 100,088 MHD patients from DaVita dialysis clinics in the US (2001–2009) and hypothesized that survival is better across higher levels of nPNA, (nPCR, a dietary protein intake surrogate) with consistent trends across race and in hypoalbuminemic patients. Time-averaged Cox models were used to estimate death hazard ratios for quarterly averaged nPNA categories controlled for case-mix, comorbidity, dialysis dose, and available markers of malnutrition-inflammation-complex syndrome (MICS). In all patients, both low (<0.6 g/kg/day, HR 1.53, [1.47–1.59]) and high nPNA (≥1.4 g/kg/day, HR 1.26, [1.19-1.34]) were associated with higher all-cause mortality when compared with the reference (1.0–<1.1 g/kg/day). This reverse–J–shape association was also found in sub-analyses performed among racial groups and in hypoalbuminemic patients (Figure). Hence, hypoalbuminemic patients of all races may benefit from higher protein intake, which needs controlled trial to verify.