Daily hemodialysis and nutritional status

general population has been demonstrated for body size [2] and serum cholesterol [3] and has beeen postulated to be due to malnutrition [3]. We agree with Canavese et al that a great deal of research is still necessary regarding the biological mechanisms of homocysteine metabolism in patients with ESRD and their relationship to cardiovascular risk. The finding of differing TT genotype prevalence over years of dialysis reported in these two studies is not irreconciliable. There may be other differences in the design of the studies that might explain variable risk estimates, including clinical status, sample size, measurement issues, Fig. 1. Time trends in evolution of lean body mass (LBM) after switch and race/ethnicity composition. We intend to examine from conventional to daily hemodialysis in 7 patients with a 12-month follow-up data from our study and agree that experience follow-up. It significantly increased within the first 6 months (P 0.02), reported from other centers is greatly needed. and remained stable thereafter. Value at t0 represents the average Routine screening of either homocysteine or genetics between the values obtained at times 3 and 0, respectively. Mean weekly ( SEM) standard Kt/V [2] increased from 2.22 0.13 at in not routinely recommended. A professional organizabaseline to 3.25 0.20 at 12 months (P 0.001). tion weighing the merits of such a clinical policy should take into consideration the cost-effectiveness of the test and associated interventions. In our clinic, the costs of such tests are significantly lower than those mentioned Fourteen volunteer patients were evaluated during 3 by Canavese et al. months on CHD and 12 months on DHD. The lean body mass was evaluated at 3, 0, 6 and 12 months, Elizabeth M. Wrone, James L. Zehnder, John M. Hornberger, Linda M. McCann, respectively. Five patients were excluded (renal transNorman S. Coplon, and Stephen P. Fortmann plantation in the first 6 months (N 4), incomplete data Palo Alto, California, USA (N 1); data from the nine patients with 6 months DHD Correspondence to Elizabeth Wrone, M.D., Stanford Center for Refollow-up (six men, three women; 61 years old, range: search in Disease Prevention, 1000 Welch Road, Palo Alto, California 30 to 76 years), on CHD (five at home, three in a low94304-1825, USA. care unit, one in hospital) for 63 months (range: 8 to 137 E-mail: [email protected] months) was analysed by ANOVA for repeated meaREFERENCES sures with F or Friedman tests, as appropriate. The lean body mass (mean SEM) increased ( 1.3 1. Wrone EM, Zehnder JL, Hornberger JM, et al: An MTHFR 0.4 kg) during the first 6 months (P 0.008) of DHD, variant, homocysteine, and cardiovascular comorbidity in renal disease. Kidney Int 60(3):1106–1113, 2001 while total body weight remained unchanged. After 6 2. Leavey SF, Strawderman RL, Jones CA, et al: Simple nutritional months, two more patients were withdrawn (renal transindicators an independent predictors of mortality in hemodialysis plantation and aortic valve replacement, respectively). patients. Am J Kidney Dis 31:997–1006, 1998 3. Coresh J, Longenecker JC, Miller ER, III, et al: Epidemiology The lean body mass evolution of the remaining seven of cardiovascular risk factors in chronic renal disease. J Am Soc patients is presented (Fig. 1). Nephrol 9:S24–S30, 1998 Based on these observations, a switch to DHD could be proposed to CHD patients with poor nutritional status. Further studies, including a larger number of patients, are required to confirm these encouraging results. Daily hemodialysis Eric Goffin, Yolande Pirard, Julie Francart, Mercedes Vignioble, Tony Goovaerts, and nutritional status Annie Robert, and Yves Pirson Brussels, Belgium