application) The 250,000 chronic dialysis patients in the US have an increased rate of malnutrition and inflammation, which are felt to be major risk factors for their high morbidity and mortality. The risk of cardiovascular death appears to be especially high among these individuals. To date, there is no uniform, practical tool for assessment of nutritional status, inflammation and food intake in dialysis patients. The goals of this prospective cohort study are to determine whether the nutritional and inflammatory states in dialysis population affect the mortality, morbidity, and other clinical outcomes in a predictable way and to ascertain how the deterioration of these indices over time is associated with poor outcome. To achieve these goals, we will study a cohort of dialysis patients in the San Francisco Bay Area prospectively. Nutritional assessment will be performed periodically. A convenient but reliable nutritional scoring system to predict the mortality and clinical outcome in the dialysis population will be developed and validated. The following specific questions will be answered: 1) Are the dialysis mortality and risk of cardiovascular death associated with malnutrition or inflammation? 2) Do malnutrition and/or inflammation and their deterioration over time have measurable, distinct impact on relevant clinical outcomes in dialysis patients such as hospitalization and erythropoietin resistance? 3) Can a numerical result of a uniform nutritional scoring system be a reliable predictor of dialysis morbidity and mortality? 4) Can a food questionnaire reliably detect deficient nutrient intake in dialysis patients? As a Mentored Patient-Oriented Research Career Development Award, this proposal also aims to develop the research abilities of the PI, and enables him to be a productive independent researcher.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
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Rankin, Tracy L
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Rattanasompattikul, Manoch; Molnar, Miklos Z; Zaritsky, Joshua J et al. (2013) Association of malnutrition-inflammation complex and responsiveness to erythropoiesis-stimulating agents in long-term hemodialysis patients. Nephrol Dial Transplant 28:1936-45
Kalantar-Zadeh, Kamyar; Ikizler, T Alp (2013) Let them eat during dialysis: an overlooked opportunity to improve outcomes in maintenance hemodialysis patients. J Ren Nutr 23:157-63
Kim, Youngmee; Molnar, Miklos Z; Rattanasompattikul, Manoch et al. (2013) Relative contributions of inflammation and inadequate protein intake to hypoalbuminemia in patients on maintenance hemodialysis. Int Urol Nephrol 45:215-27
Franch, Harold; Kalantar-Zadeh, Kamyar (2013) World Renal Nutrition Week Congress: from Hawaii to Germany. J Ren Nutr 23:194
Rattanasompattikul, Manoch; Feroze, Usama; Molnar, Miklos Z et al. (2012) Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients. Int Urol Nephrol 44:1813-23
Feroze, Usama; Kalantar-Zadeh, Kamyar; Sterling, Kevin A et al. (2012) Examining associations of circulating endotoxin with nutritional status, inflammation, and mortality in hemodialysis patients. J Ren Nutr 22:317-26
Noori, Nazanin; Caulfield, Michael P; Salameh, Wael A et al. (2011) Novel lipoprotein subfraction and size measurements in prediction of mortality in maintenance hemodialysis patients. Clin J Am Soc Nephrol 6:2861-70
Noori, Nazanin; Kovesdy, Csaba P; Dukkipati, Ramanath et al. (2011) Racial and ethnic differences in mortality of hemodialysis patients: role of dietary and nutritional status and inflammation. Am J Nephrol 33:157-67
Taylor, Lynn M; Kalantar-Zadeh, Kamyar; Markewich, Theodore et al. (2011) Dietary egg whites for phosphorus control in maintenance haemodialysis patients: a pilot study. J Ren Care 37:16-24
Feroze, Usama; Noori, Nazanin; Kovesdy, Csaba P et al. (2011) Quality-of-life and mortality in hemodialysis patients: roles of race and nutritional status. Clin J Am Soc Nephrol 6:1100-11

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