MO603
PREVALENCE AND PROGNOSTIC SIGNIFICANCE OF MALNUTRITION IN DIALYSIS PATIENTS UNDERGOING ENDOVASCULAR THERAPY FOR PERIPHERAL ARTERY DISEASE

Malnutrition often coexists with inflammation and atherosclerosis and is associated with adverse clinical outcomes in dialysis patients. However, both prevalence and prognostic significance of preexisting malnutrition in dialysis patients with peripheral artery disease (PAD) referred for endovascular therapy are not well known.

A prospective cohort of 395 dialysis patients undergoing endovascular therapy for PAD between 2005 and 2019 was studied. Nutritional status was assessed at admission by using the Controlling Nutritional Status (CONUT) score, a simple tool incorporating serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration. Patients were divided into 4 groups based on the CONUT score: normal nutrition (0–1), mild malnutrition (2–4), moderate malnutrition (5–8), and severe malnutrition (9–12). We examined the associations between malnutrition and all-cause mortality as well as major adverse limb events (MALE) and major adverse cardiovascular events (MACE) using Cox proportional hazards models.

According to the CONUT score, 40.8% patients were moderately or severely malnourished. During a median follow-up of 2.1 years, 218 (55.2%) patients died, 211 (53.4%) patients had MALE, and MACE occurred in 135 (34.2%) patients. Severely malnourished patients, as compared to patients with normal nutritional status, had significantly increased risk for all-cause death (adjusted hazard ratio [HR], 4.83; 95% confidence interval [CI], 2.56 to 9.12) and in particular non-cardiovascular death (adjusted HR, 7.20; 95% CI, 3.22 to 16.08) and MALE (adjusted HR, 2.42; 95% CI, 1.23 to 4.74) but not MACE (adjusted HR, 1.81; 95% CI, 0.74 to 4.40). Similar results were found when the CONUT score was analyzed as a continuous variable.

Malnutrition is common and is strongly associated with increased all-cause mortality and MALE among dialysis patients with PAD requiring endovascular therapy. Clinical trials are needed to evaluate whether nutritional interventions improve outcomes for dialysis patients with PAD.