Better nutrition at the start of dialysis among people with kidney failure is linked to a higher survival rate over the next five years, according to a new study published in the Journal of Renal Nutrition.
Dialysis refers to the removal of waste products from the blood in people whose kidneys are no longer able to do this, most commonly due to diabetic kidney disease. The most common form of dialysis is hemodialysis, in which people visit a dialysis center several times each week and are connected to a machine that filters waste products from the blood. While dialysis or a kidney transplant is necessary for survival in people with kidney failure (also called end-stage kidney disease), most people who need dialysis are in poor health with many serious chronic health problems, and many die within a few years of starting the treatment. Among people on dialysis, those with diabetes have been shown to have a higher death rate than those who don’t have diabetes. But certain factors have also been shown to reduce the risk of death among people on dialysis, including getting more physical activity.
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For the latest study, researchers were interested in how nutrition affected the risk of dying in people who were starting on dialysis — both when it came to their nutrition at the time they started, and any nutritional improvements they made soon after starting on dialysis. They looked at data from 297 people who started on dialysis between March 2009 and March 2019, and measured each participant’s nutritional status based on their answers to questions and a scoring method called the Integrative Clinical Nutrition Dialysis Score (ICNDS). In particular, the researchers looked at participants’ ICNDS scores at the time they started dialysis, and during their first three months on dialysis. ICNDS scores range from 0 to 100, with a higher number indicating better nutrition.
Better nutrition linked to improved survival rates in those on dialysis
The researchers found that participants who started dialysis with an ICNDS score of 75 or higher were 2.5 times as likely to be alive after one year compared with those with a lower score, and 1.5 times as likely to be alive after five years. What’s more, a deteriorating nutrition status at the start of dialysis — meaning that a person’s ICNDS scores got worse during the first three months of dialysis — was linked to 1.7 times the risk of dying during the period of one to three years after starting dialysis, compared with stable or improved nutritional status during the first three months of dialysis.
“The results of our research call for special attention for pre-dialysis care,” the researchers wrote. “We suggest a multidisciplinary approach that includes attention to diet and provision of adequate treatment for comorbidities in the period before initiation of dialysis, with the aim of increasing the ICNDS during the transition” to dialysis. More research is needed, though, to find out what kinds of nutritional interventions are most likely to result in lasting dietary changes, and what effect these interventions have on long-term survival in people undergoing dialysis.
Want to learn more about keeping your kidneys healthy with diabetes? Read “Managing Diabetic Kidney Disease,” “How to Keep Your Kidneys Healthy,” “Protecting Your Kidneys,” and “Kidney Disease: Your Seven-Step Plan for Prevention.”
