Abstract
Background and ObjectivesProtein-energy wasting is common in long-term haemodialysis (HD) patients with chronic kidney disease and is associated with increased morbidity and mortality. The creatinine index (CI) is a simple and useful nutritional parameter reflecting the dietary skeletal muscle protein intake and skeletal muscle mass of the patient. Because of the complexity of creatinine kinetic modeling (CKM) to derive CI, we developed a more simplified formula to estimate CI in HD patients.Design, Setting, Participants & MeasurementsA large database of 549 HD patients followed over more than 20 years including monthly CKM-derived CI values was used to develop a simple equation based on patient demographics, predialysis serum creatinine values and dialysis dose (spKt/V) using mixed regression models.ResultsThe equation to estimate CI was developed based on age, gender, pre-dialysis serum creatinine concentrations and spKt/V urea. The equation-derived CI correlated strongly with the measured CI using CKM (correlation coefficient = 0.79, p-value <0.001). The mean error of CI prediction using the equation was 13.47%. Preliminary examples of few typical HD patients have been used to illustrate the clinical relevance and potential usefulness of CI.ConclusionsThe elementary equation used to derive CI using demographic parameters, pre-dialysis serum creatinine concentrations and dialysis dose is a simple and accurate surrogate measure for muscle mass estimation. However, the predictive value of the simplified CI assessment method on mortality deserves further evaluation in large cohorts of HD patients.
Highlights
Protein-energy wasting (PEW) is highly prevalent among the hemodialysis (HD) population [1,2]
The equation to estimate creatinine index (CI) was developed based on age, gender, pre-dialysis serum creatinine concentrations and spKt/V urea
A visceral protein indicator, is routinely assessed and is inversely associated with mortality in HD patients [3,4,7,8], it is an insensitive confounding factor being an indicator of both inflammation and nutritional status [9,10]
Summary
Protein-energy wasting (PEW) is highly prevalent among the hemodialysis (HD) population [1,2]. In addition to assessment of visceral proteins, the evaluation of somatic protein status by determination of muscle mass is crucial and commonly used for nutritional assessment of dialysis patients [6]. The association of serum creatinine level with LBM and an inverse correlation between serum creatinine concentration and mortality in HD patients [4,8,12] support the use of serum creatinine as a nutritional and muscle mass marker and a predictor of clinical outcomes in these patients [13]. Serum creatinine concentration could be influenced by patient muscle mass, dietary protein intake, hydration status, dialysis clearance and the presence of residual renal function [14,15]. Because of the complexity of creatinine kinetic modeling (CKM) to derive CI, we developed a more simplified formula to estimate CI in HD patients
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