Prognostic markers in haemodialysis patients (albumin, phosphate, PTH)
Core concept
- Annual mortality on haemodialysis is ~15-20% - comparable to many metastatic cancers
- Cardiovascular death ~40-50%, and it is arrhythmic/sudden death more than atherosclerotic MI
- Infection is the second commonest cause (vascular access related)
- Low serum albumin is the strongest and most consistent single predictor of mortality
- It is not simply "malnutrition" - it reflects inflammation (negative acute-phase reactant), comorbidity burden, volume overload and protein-energy wasting
- The MIA syndrome: Malnutrition - Inflammation - Atherosclerosis
- Feeding a patient with a low albumin does not correct it if the driver is inflammation
3 more sections, plus exam facts
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