This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. 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 affects 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 360 hemodialysis patients 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 of 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 nutrition intake in dialysis patients?
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