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Malnutrition in hemodialysis diabetic patients: Evaluation and prognostic influence. Background. This work aimed to evaluate the role of malnutrition in the increased mortality rate of hemodialysis diabetic patients from a French cooperative series. Methods. Body mass index (BMI), serum albumin, prealbumin, cholesterol, and pre-dialysis creatinine, normalized protein catabolic rate and lean body mass (LBM) were measured in 734 diabetic and 6389 non-diabetic patients (aged 63.4 ± 12.2 and 62.0 ± 15.9 years; 1.01 male to 1.40 female ratio). The outcome of 1610 of these patients, including 170 diabetics, was assessed during a 30-month follow-up. Results. Diabetic as compared to non-diabetic patients showed a significant (P < 10 -4 ) increased BMI (25.9 ± 5.2 vs. 23.1 ± 4.3) and cholesterol (5.5 ± 1.6 vs. 5.3 ± 1.5 mmol/L), and decreased albumin (37.8 ± 5.4 vs. 38.9 ± 5.3 g/L), prealbumin (317 ± 91 vs. 340 ± 94 mg/L), creatinine (711 ± 184 vs. 816 ± 217 μmol/L) and LBM (76 ± 18 vs. 87 ± 21%). Normalized protein catabolic rate was similar in the two groups (1.11 ± 0.31 vs. 1.13 ± 0.32 g/kg/L). One and two-year survival was 83.7 ± 2.9% and 65.5 ± 3.8% in diabetic patients versus 90.3 ± 0.8% and 79.9 ± 1.1% in non-diabetics (relative risk 1.26, P < 0.01). Independent predictors of survival were age, albumin and prealbumin in non-diabetics and only age in diabetics. Conclusion. Diabetic patients compared to non-diabetics were characterized by an increased incidence of protein malnutrition and decreased survival. However, the higher death risk associated with diabetes was not related to malnutrition. [ABSTRACT FROM AUTHOR]

Prealbumin is as important as albumin in the nutritional assessment of hemodialysis patients. Background. Although serum prealbumin is considered a valid indicator of nutritional status in hemodialysis patients, there is relatively little evidence that its determination is of major prognostic significance. In this study, we aimed to determine the independent association of serum prealbumin with survival in hemodialysis patients, after adjusting for serum albumin and other indicators of protein energy nutritional status. Methods. Serum prealbumin was measured in more than 1600 maintenance hemodialysis patients. We determined the correlations among prealbumin and other indicators of nutritional status, including serum albumin, and bioimpedance-derived indicators of body composition. The relationship between serum prealbumin and survival was determined using proportional hazards regression. Results. The serum albumin was directly correlated with the serum prealbumin (r = 0.47, P < 0.0001), but still explained <25% of the variability in prealbumin. Prealbumin was inversely related to mortality, with a relative risk reduction of 6% per 1 mg/dL increase in prealbumin, even after adjusting for case mix, serum albumin, and other nutritional indicators. The increase in risk with lower serum prealbumin concentrations was observed whether the serum albumin was high or low. Conclusion. In hemodialysis patients, the serum prealbumin provides prognostic value independent of the serum albumin and other established predictors of mortality in this population. [ABSTRACT FROM AUTHOR]