Nutritional assessment in a hospital dialysis ward for patients at high comorbidity. State of the art and basis for future research. The MANDALA study MANger (bien) en Dialyse pour une ALimentation Adaptée

The diet and dialysis dyad is differently modulated in different Countries and international comparison may helping in identifying common patterns and specificities. With this aim we compare two hospital treated cohorts on hemodialysis-hemodiafiltration in France and Italy. We used questionnaires and biochemical data for valutation of nutritional assessment. The settings are public dialysisCenters, with the only beds for hospitalisation in Nephrology iin the area, in cities of about 300,000 inhabitants, with a wider referral area (about 800,000 inhabitants). In both settings the patients treated in hospital were negatively selected, since out of hospital networks ensure dialysis to cases with lower case-mix. Data on 207 patients were analysed (Italy (IT):97, France (FR):110). There were significant baseline differences in age (IT: median 67, FR: 71 p<0.001), and also as a consequence, of comorbidity (Charlson index: median IT:6 ; FR:9, p<0.01). Conversely RRT vintage significantly higher in IT (median 10.0 vs 3.7 years p<0.001). As concerned the characteristics of dialysis in the two groups, use of hemodiafiltration was higher in FR, no significant difference was found in KT/v and nPCR. In the overall population, as well as in the two Centers, no significant relationship (linear, quadratic and U shape models) was found between all the tested combinations of comorbidity index (Charlson), albumin levels, kt/v and nPCR (Daugurdas 2), Malnutrition Inflammation Index (MIS index). Conversely, suggesting a role for albumin losses in HDF, albumin levels were lower in the FR population, while cholesterol level was superimposable. No significant relationship among nutritional or comorbidity biomarker was also found when IT and FR cohorts were analysed separately. The lack of significant correlation between the classic comorbidity indexes in a high-comorbidity dialysis cohort underlines the need for a systematic reassessment of their significance in these populations, as a guide for dialysis prescriptions andas outcome merker over follow-up, indirectly supporting an individualised dialysis approach.