Abstract
BackgroundProtein-energy wasting (PEW) is a frequently observed complication that leads to increased mortality in hemodialysis patients. However, a multifaceted assessment of PEW by combined objective nutritional parameters has not yet been established.MethodsIn total, 144 Japanese patients receiving maintenance hemodialysis at a hemodialysis center were retrospectively followed for 7 years. The primary outcome was all-cause death. The main exposure was a modified simple PEW score (0, 1, 2, 3, or 4), calculated from four parameters: serum albumin and creatinine levels, normalized protein catabolic rate, and body mass index. These parameters are included in the subcategories of PEW as defined by the International Society of Renal Nutrition and Management. The cutoff values of the modified simple PEW score components were based on the receiver operating characteristics curves determined by univariate logistic regression analyses. Risk estimates for all-cause mortality were calculated by the Cox proportional hazards model adjusted for potential confounding factors.ResultsDuring the median 5.7-years follow-up period, 37 patients died of any cause. When patients were divided into three subgroups (G1–G3) based on the modified simple PEW score, a multivariable-adjusted analysis showed that the risks of all-cause death in groups G2 and G3 were significantly higher than in the lowest score group (G1), with hazard risk (95% confidence interval) 3.10 (1.16–8.26) (P = 0.024) and 5.68 (1.85–17.45) (P = 0.002), respectively.ConclusionsThe modified simple PEW score is a useful composite indicator of nutritional status that stratifies the risk of all-cause mortality in patients undergoing maintenance hemodialysis.
Highlights
Malnutrition or undernutrition is common in patients receiving hemodialysis [1]
Determination of cutoff values for each Protein-energy wasting (PEW) parameter In total, 144 Japanese patients undergoing maintenance hemodialysis were included in the present analysis
After considering the distribution of the four parameters of PEW in the hemodialysis patients registered in the database of the Japanese Society for Dialysis Therapy ((https:// www.jsdt.or.jp/Overview_2.html) and the original cutoff values of the International Society of Renal Nutrition and Management (ISRNM), we rounded the cutoff values of body mass index (BMI), serum Cr Cr/body surface area (BSA), and normalized protein catabolic rate (nPCR) and set the cutoff values for the four categories of PEW as 3.8 g/dL for serum albumin, 18.5 kg/m2 for BMI, 500 μmol/L/m2 for serum Cr/BSA, and 0.8 g/kg/day for nPCR
Summary
The underlying causes for malnutrition in these patients are attributed to increased catabolism, decreased appetite and food intake, nutrient loss through the hemodialyzer, and dietary protein restriction for phosphate control [2] These patients are at increased risk for morbidity and mortality [3]. The ISRNM proposed diagnostic criteria for PEW with four distinct categories: (i) biochemical indicators such as serum albumin or prealbumin; (ii) low body weight, reduced fat, or weight loss; (iii) decreased muscle mass; and (iv) low protein or energy intake. Serum levels of albumin and creatinine (Cr), normalized protein catabolic rate (nPCR), and body mass index (BMI) were used for the score calculation These nutritional parameters are established nutritional markers and reported to be associated with mortality in patients receiving hemodialysis [6,7,8,9]. A multifaceted assessment of PEW by combined objective nutritional parameters has not yet been established
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
