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Pathogenesis and treatment of malnutrition in maintenance dialysis

Marsha Wolfson, MD, FACP
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD


Malnutrition is an important problem in patients treated with chronic hemodialysis or peritoneal dialysis. It occurs in 20 to 70 percent of patients (depending upon the method used to measure nutritional status), with an increasing length of time on dialysis correlating with an increasing decline in nutritional parameters [1-3].

There may be significant differences between countries with respect to some measures of nutritional status, such as serum albumin concentration [4]. Based upon the Dialysis Outcomes and Practice Patterns Study (DOPPS), for example, the following mean serum albumin levels were reported in France (3.87 mg/dL), Germany (4.17 mg/dL), Italy (3.98 mg/dL), Spain (3.98 mg/dL), the United States (3.6 mg/dL), and the United Kingdom (3.72 mg/dL) [4]. However, since differences in measurement methods cause differences in results, the method used from laboratory to laboratory and country to country must be known to assess any true differences in serum albumin in an individual patient or groups of patients.

Two important issues are discussed elsewhere:

How is nutritional status evaluated? (See "Assessment of nutritional status in end-stage renal disease".)

What is the relation between nutritional status and survival? Patients with malnutrition, as manifested in part by hypoalbuminemia, measured at the onset of or during maintenance dialysis, have an increased mortality rate (figure 1A-B). This is true for patients treated with either maintenance hemodialysis or peritoneal dialysis [5-8]. (See "Patient survival and maintenance dialysis".)


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Literature review current through: Sep 2016. | This topic last updated: Feb 20, 2014.
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