Potential Impact of Nutritional Intervention on End-Stage Renal Disease Hospitalization, Death, and Treatment Costs

Abstract

Objective: Our objective was to estimate the effect of an improvement in nutrition, represented by albumin concentrations, on hospitalization, mortality, and Medicare end-stage renal disease (ESRD) program cost. Design: Based on published trials, the impact of an improvement in serum albumin of +0.2 g/dL from a hypothetical nutritional program for severely malnourished patients with albumin ≤3.5 g/dL (base case) was estimated by reassigning patients to higher albumin categories, along with outcome risks associated with the new albumin category. Setting: Data from Fresenius Medical Care North America (Waltham, MA) were utilized in regression models to determine the association between albumin and change in albumin concentration with outcomes. Results: Albumin ≤3.5 g/dL was associated with a >2-fold increase in death and hospitalization risk, compared to ≥4 g/dL (P