Potential impact of nutritional intervention on end-stage renal disease hospitalization, death, and treatment costs.

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 Conclusion Nutritional interventions that increase serum albumin by ≥0.2 g/dL (e.g., via oral nutritional supplements) may lead to considerable improvements in mortality, hospitalization, and treatment costs.