Influence of protein catabolic rate on nutritional status, morbidity and mortality in elderly uraemic patients on chronic haemodialysis: a prospective 3-year follow-up study

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Abstract
It has been recently reported that elderly chronic haemodialysis (CHD) patients have a reduced protein catabolic rate (PCRn) in spite of an adequate Kt/V. However until now the long-term consequences of this fact on the nutritional status, morbidity, and mortality were not known. This prospective study evaluates, over a period of 3 years, the effect of the reduced PCRn on some nutritional parameters, morbidity and mortality in CHD patients older than 65 years with adequate and stable Kt/V. Over the period 1990–1993 we evaluated 42 CHD patients over 65 years (mean±SD 72±5 years). PCRn, total serum proteins, serum albumin concentration, body weight, body mass index (BMI) and serum transferrin were determined at the start of the study and followed yearly until the end of observation. The incidence of hospitalization/patient-year, the mortality rate and the causes of death were also recorded. All the patients were managed to maintain a Kt/V>0.9 throughout the study. Twenty-two patients (Group A), mean age 70±4 years, completed the entire period of observation. Their Kt/V was 1.10±0.12, PCRn was 0.95±0.12 g/kg/day, and serum albumin concentration was 40.2±1.5 g/l, and these did not change significantly. The other parameters also remained stable over time. Twenty patients (Group B) died. Their mean age was 74±6 years. This group's Kt/V was 1.11±0.15, PCRn was 0.94±0.18 g/kg/day, and serum albumin concentration was 39±3.1 g/l, and there were no significant variations between the start and the end of observation for all the parameters studied. There were no differences between the two groups of patients at the start of observation for all the parameters with the exception of age, which was significantly higher in patients in Group B (P=0.017). The data derived by the Cox proportional hazards regression model showed that PCRn and serum albumin concentration were not significant predictors of death, as well as Kt/V, total serum proteins, BMI, total number of risk factors and number of hospital admissions/patient-year, but confirmed the predominant role of age (Pt/V have PCRn values lower than those commonly suggested as necessary to prevent chronic malnutrition. However, this reduced protein intake did not exert any specific negative influence on the nutritional status, morbidity and mortality after a follow-up of 3 years. It is possible that, in this group of patients, a declining PCRn with age does not indicate impending malnutrition and does not influence morbidity and mortality. Therefore age remains the strongest factor influencing mortality.

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