Improvement of nutritional status after initiation of maintenance hemodialysis

Background: Recent data suggest that serum albumin concentrations increase during the several month-period that follows the initiation of maintenance hemodialysis (MHD) therapy. Some investigators have shown that the rate of increase in serum albumin level is related directly to 24-hour urine protein losses before the initiation of dialysis therapy. However, serum albumin levels increase even in patients starting MHD therapy without significant proteinuria, suggesting that this increase may be one manifestation of improving protein-energy nutritional status associated with commencing MHD therapy. We examined this question by reviewing records of all patients admitted to our outpatient dialysis unit within 30 days of initiation of MHD therapy. Methods: Ninety-seven patients qualified for the study. Their routine laboratory test results beginning with the time of admission to the outpatient unit until month 6 of chronic dialysis therapy were analyzed. Results: Between months 1 and 6, there was a statistically significant increase in values for predialysis serum albumin, iron, transferrin saturation, creatinine, and normalized protein equivalent of total nitrogen appearance (nPNA). Many of these values were still increasing by month 6. Body weight declined initially until month 4, then increased. There was a strong curvilinear relationship between mean nPNA and final serum albumin level. Conclusions: Our results suggest that an improvement in nutritional status, including an increase in dietary protein intake and serum albumin level, often occurs with the initiation of MHD therapy. The improvement in nutritional status may be related to the increase in dietary protein intake. (C) 2002 by the National Kidney Foundation, Inc.