Cross-sectional relationship between dietary protein and energy intake, nutritional status, functional status, and comorbidity in older versus younger hemodialysis patients

Objective: To evaluate the dietary energy intakes (DEI) and dietary protein intakes (DPI) of older (greater than or equal to 65 years), middle-aged (50 to 64 years), and younger (< 50 years) maintenance hemodialysis patients enrolled in the Hemodialysis (HEMO) Study, and to describe the relationship between age, nutritional status, functional status, and comorbidity. Design: A cross-sectional analysis of the first 1,397 participants in baseline (before randomization) was performed. Main Outcome Measures: DEI and DPI, serum albumin, creatinine, total cholesterol, normalized protein catabolic rate (nPCR), equilibrated nPCR (enPCR), functional status, and comorbidities. Results: Mean DEI, DPI, serum albumin, creatinine, nPCR, and enPCR were significantly lower in the older compared with the younger patients, despite similar doses of dialysis as measured by equilibrated Kt/V. Mean DEI, DPI, nPCR, and enPCR were not significantly different between the middle-aged and older patients, whereas albumin and creatinine were significantly lower in the older patients. Mean dry weight and percent of standard body weight in the younger and older patients were similar. In all groups, mean DEI was lower than both the HEMO study's standard of care (SOC) and the Kidney Disease Outcomes Quality Initiative (K/DOQI) nutrition recommendations, whereas mean DPI was lower than the SOC and K/DOQI recommendations only in the middle-aged and older patients. Middle-aged and older patients had higher cholesterol, lower functional status, and more comorbidities than the younger patients. Conclusion: Middle-aged and older maintenance dialysis patients may be at greater risk for developing protein-energy malnutrition than their younger counterparts. Inadequate DEI and DPI reported in middle-aged and older patients were associated with lower levels of biomarkers of nutritional status, lower functional status, and higher comorbidities than in the younger patients. (C) 2002 by the National Kidney Foundation, Inc.