Despite significant improvements in dialysis treatments, currently over 20% of the 350,000 maintenance hemodialysis (MHD) patients in the United States die each year. A study published in Hemodialysis International finds that this high mortality rate may be attributed to malnutrition.

MHD patients experience what has been termed the “obesity paradox,” wherein obesity is associated with increased chance of survival. “A larger body fat mass as seen in obesity probably represents protective reserves that may mitigate the adverse effects of malnutrition in patients,” according to Kamyar Kalantar-Zadeh M.D., author of the study.

MHD patients tend to have a high degree of protein-energy malnutrition and inflammation. The combination of these two conditions, termed Kidney Disease Wasting (KDW), leads to increased risk of death. Conversely, it has been shown that an increase in protein intake yields the greatest survival in patients.

The study suggests that improved diet as well as appetite-stimulating agents may be a way to improve nutrition and, consequently, outcome in MHD patients. Understanding the factors that lead to KDW will be the key to improving survival in MHD patients, as well as in the 20 to 40 million Americans who exhibit similar risk-factor paradoxes such as those with chronic heart failure, AIDS, rheumatoid arthritis and malignancy.

This study is published in Hemodialysis International.