J Nephropathol. 2023;12(2): e17301.
doi: 10.34172/jnp.2022.17301
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  PDF Download: 190

Original Article

The relationship of nutrition status and dietary intake with hospitalization and mortality in hemodialysis patients; a single-center observational cohort study

Janet Diaz-Martinez 1* ORCID logo, Carlos Bejar 2, Ivan Delgado-Enciso 1,3 ORCID logo

1 Florida International University, Department of Dietetics and Nutrition, Robert Stempel College of Public Health, Miami, Florida, USA
2 The Kidney and Hypertension Group, Florida, USA
3 Department of Molecular Medicine, School of Medicine, University of Colima, and Institute of Cancer, Colima State Health Services, Colima, Mexico
*Corresponding Author: Corresponding author: Janet Diaz-Martinez, Email:, Email: jmart556@fiu.edu


Introduction: No single nutrition parameter can accurately assess nutritional status, to predict outcomes and to drive the priorities for nutrition care in patients undergoing hemodialysis (HD).

Objectives: The aim of this study was to assess the nutritional status of HD patients using two validated assessment tools; the “7-point subjective global assessment” (SGA) and “malnutrition inflammation score” (MIS); to determine participants’ daily energy intakes (DEI) and daily protein intakes (DPI); and also to examine the relationship of these parameters with hospitalization and mortality.

Patients and Methods: This is a 12-month prospective, single HD-center study that recruited 77 HD participants from an outpatient center in South Florida. For the purpose of this analysis, participants with SGA ≤ 5 and MIS > 7 and were considered to have an inadequate nutritional status represented by SGA-I and MIS-I, respectively. Inadequate energy (DEI-I) and inadequate protein (DPI-I) intake were defined using cutoff values. The outcomes and endpoints of this study were hospitalizations and mortality, registered over 12 months.

Results: Fifty-five male and 22 female patients from a single HD center participated in the study. During the 12-month study, 63.6% of participants were hospitalized, 7% transplanted and 13% died. The group of participants with an inadequate nutritional status (defined as SGA-I and MIS-I) and inadequate energy intake (defined as DEI-I) had an increased hazard ratio for mortality [SGA-I and DEI-I [HR: 7.18 (95% CI: 1.18-43.43; P= 0.032] and [MIS-I and DEI-I [HR: 13.23, 95% CI: 2.1-83.2; P=0.006] and the likelihood of hospitalization increased almost 3-fold [HR: 2.73, 95% CI: 1.09-6.842; P=0.031], in the case of MIS-I.

Conclusion: These results indicated that energy intake lower than 25 kcal/kg/day increases the risks of hospitalization and mortality for those HD patients with an impaired nutritional status.

Implication for health policy/practice/research/medical education:

The current study indicates a deleterious effect of a daily energy intake below 25 kcal/kg in combination with inadequate nutritional status which may be an important consideration in determining the nutrition goals and priorities among malnourished patients living with hemodialysis.

Please cite this paper as: Diaz-Martinez J, Bejar C, Delgado-Enciso I. The relationship of nutrition status and dietary intake with hospitalization and mortality in hemodialysis patients; a single-center observational cohort study. J Nephropathol. 2023;12(2):e17301. DOI: 10.34172/ jnp.2022.17301.

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Submitted: 18 Oct 2021
Accepted: 03 Feb 2022
ePublished: 19 Feb 2022
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