Diabetics who delay dialysis may improve outcome

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The nutritional status of patients with diabetes and chronic kidney disease can be maintained or even improved before they begin hemodialysis. However, the nutritional status deteriorates in those who have to start dialysis right away.

Poor nutritional status is a consequence of chronic kidney disease, which was well-documented even before dialysis became widely available, Dr. Christelle Raffaitin and colleagues from Universite Victor Segalen-Bordeaux, France, point out. “It is now recognized as an important predictor of the prognosis for patients starting dialysis.”

In their study, the researchers followed 45 diabetes patients (average age 65 years) with chronic kidney disease who were enrolled in a cooperative-care program designed to control glucose levels, blood pressure, cholesterol, and the excretion rate of albumin, a protein used to measure kidney function.

The team compared the patients’ glomerular filtration rate and blood albumin level—tests used to measure kidney function—along with body composition and resting energy expenditure - a measure of how the body is utilizing calories, before study began and again 2 years later.

In the 35 patients who did not start dialysis during the 2-year follow-up, improvements were observed in blood sugar levels, blood pressure, low-density lipoprotein cholesterol, and albumin excretion rate. Their glomerular filtration rate declined slowly. Increases were also seen in body mass index (the ratio of height to weight often used to determine if a person is under- or overweight), lean body mass, and blood albumin level.

Ten patients required dialysis before the 2-year follow-up was completed, according to the study findings, published in the American Journal of Clinical Nutrition.

“At the second evaluation (i.e., after beginning dialysis), the patients on hemodialysis had lost weight because of a significant loss of lean body mass, and their serum albumin concentrations became significantly lower than those of severe chronic kidney disease patients not on hemodialysis,” Raffaitin’s group reports.

The nutritional status improved in the chronic kidney disease patients with well-controlled diabetes and who did not start dialysis,” they investigators report, “and it deteriorated in patients who started dialysis.”

SOURCE: American Journal of Clinical Nutrition, January 2007.

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