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Criteria for classification of protein–energy wasting in dialysis patients: impact on prevalence

  • Carolina Gracia-Iguacel (a1) (a2) (a3), Emilio González-Parra (a1) (a2) (a3), Ignacio Mahillo (a1) and Alberto Ortiz (a1) (a2) (a3)

Abstract

Malnutrition is highly prevalent in dialysis patients and associated with poor outcomes. In 2008, protein–energy wasting (PEW) was coined by the International Society of Renal Nutrition and Metabolism (ISRNM), as a single pathological condition in which undernourishment and hypercatabolism converge. In 2014, a new simplified score was described using serum creatinine adjusted for body surface area (sCr/BSA) to replace a reduction of muscle mass over time in the muscle wasting category. We have now compared PEW–ISRNM 2008 and PEW-score 2014 to evaluate the prevalence of PEW and the risk of death in 109 haemodialysis patients. This was a retrospective analysis of cross sectional data with a median prospective follow-up of 20 months. The prevalence of PEW was 41 % for PEW–ISRNM 2008 and 63 % for PEW-score 2014 (P<0·002). Using PEW-score 2014: twenty-nine patients (27 %) had severe malnutrition (PEW-score 2014 0–1) and forty (37 %) with moderate malnutrition (score 2). Additionally, thirty-three (30 %) patients had mild wasting and only seven patients (6 %) presented a normal nutritional status. sCr/BSA correlated with lean total mass (R 0·46. P<0·001). A diagnosis of PEW according to PEW-score 2014, but not according to PEW–ISRNM 2008, was significantly associated with short-term mortality (P=0·0349) in univariate but not in multivariate analysis (P=0·069). In conclusion, the new PEW-score 2014 incorporating sCr/BSA identifies a higher number of dialysis PEW patients than PEW–ISRNM 2008. Whereas PEW-score-2014 provides timelier and therefore more clinically relevant information, its association with early mortality needs to be confirmed in larger studies.

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Corresponding author

*Corresponding author: C. Gracia-Iguacel, email carolinagracia@fjd.es

References

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1. Keith, DS, Nichols, GA, Gullion, CM, et al. (2004) Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Inter Med 164, 659663.
2. Wen, CP, Cheng, TY, Tsai, MK, et al. (2008) All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. Lancet 371, 21732182.
3. Go, AS, Chertow, GM, Fan, D, et al. (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351, 12961305.
4. Eknoyan, G, Beck, GJ, Cheung, AK, et al. (2002) Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 347, 20102010.
5. Kalantar-Zadeh, K, Kopple, JD, Block, G, et al. (2001) A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 38, 1211263.
6. Saran, R, Li, Y, Robinson, B, et al. (2015) US renal data system 2014 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 66, Suppl. 1, S1S306.
7. Lopes, AA, Bragg-Gresham, JL, Elder, SJ, et al. (2010) Independent and joint associations of nutritional status indicators with mortality risk among chronic hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Ren Nutr 20, 224234.
8. Hecking, E, Bragg-Gresham, JL, Rayner, HC, et al. (2004) Haemodialysis prescription, adherence and nutritional indicators in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 19, 100107.
9. Fouque, D, Kalantar-Zadeh, K, Kopple, J, et al. (2008) A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease. Kidney Int 73, 391398.
10. Cano, NJ, Aparicio, M, Brunori, G, et al. (2009) ESPEN Guidelines on Parenteral Nutrition: adult renal failure. Clin Nutr 28, 401414.
11. Fouque, D, Vennegoor, M, ter Wee, P, et al. (2007) EBPG guideline on nutrition. Nephrol Dial Transplant 22, Suppl. 2, ii45ii87.
12. Moreau-Gaudry, X, Jean, G, Genet, L, et al. (2014) A simple protein–energy wasting score predicts survival in maintenance hemodialysis patients. J Ren Nutr 24, 395400.
13. Gracia-Iguacel, C, González-Parra, E, Pérez-Gómez, MV, et al. (2013) Prevalence of protein–energy wasting syndrome and its association with mortality in haemodialysis patients in a centre in Spain. Nefrologia 33, 495505.
14. Fried, L, Bernardini, J & Piraino, B (2003) Comparison of the Charlson Comorbidity Index and the Davies score as a predictor of outcomes in PD patients. Perit Dial Int 23, 568573.
15. Daugirdas, JT (1993) Second generation logarithmic estimates of single pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 4, 12051213.
16. Kopple, JD (2001) National Kidney Foundation K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. Am J Kidney Dis 37, Suppl. 2, S66S70.
17. Machek, P, Jirka, T, Moissl, U, et al. (2010) Guided optimization of fluid status in haemodialysis patients. Nephrol Dial Transplant 25, 538544.
18. Jindal, KK & Goldstein, MB (1988) Urea kinetic modeling in chronic hemodialysis: benefits, problems, and practical solutions. Semin Dial 1, 8285.
19. Hsieh, FY & Lavori, PW (2000) Sample-size calculations for the Cox proportional hazards regression model with nonbinary covariates. Control Clin Trials 21, 552560.
20. Carrero, JJ, Thomas, F, Nagy, K, et al. (2018) Global prevalence of protein–energy wasting in kidney disease: a meta-analysis of contemporary observational studies from the International Society of Renal Nutrition and Metabolism. J Ren Nutr 28, 380392.
21. Noori, N, Kovesdy, CP, Bross, R, et al. (2011) Novel equations to estimate lean body mass in maintenance hemodialysis patients. Am J Kidney Dis 57, 130139.
22. Lopes, AA, Bragg-Gresham, JL, Elder, SJ, et al. (2010) Independent and joint associations of nutritional status indicators with mortality risk among chronic hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Ren Nutr 20, 224234.
23. Drechsler, C, Grootendorst, DC, Pilz, S, et al. (2011) Wasting and sudden cardiac death in hemodialysis patients: a post hoc analysis of 4D (Die Deutsche Diabetes Dialyse Studie). Am J Kidney Dis 58, 599607.
24. Mazairac, AH, de Wit, GA & Grooteman, MP, et al (2011) A composite score of protein–energy nutritional status predicts mortality in haemodialysis patients no better than its individual components. Nephrol Dial Transplant 26, 19621967.
25. Stosovic, M, Stanojevic, M, Simic-Ogrizovic, S, et al. (2011) The predictive value of anthropometric parameters on mortality in haemodialysis patients. Nephrol Dial Transplant 26, 13671374.
26. Dai, L, Mukai, H, Lindholm, B, et al. (2017) Clinical global assessment of nutritional status as predictor of mortality in chronic kidney disease patients. PLOS ONE 12, e0186659.
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
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