Abstract
Protein-energy wasting (PEW) is associated with mortality in patients with end-stage renal disease (ESRD) on maintenance hemodialysis. The correct diagnosis of PEW is extremely important in order to predict clinical outcomes. However, it is unclear which parameters should be used to diagnose PEW. Therefore, this retrospective observational study investigated the relationship between mortality and nutritional parameters in ESRD patients on maintenance hemodialysis. A total of 144 patients were enrolled. Nutritional parameters, including body mass index, serum albumin, dietary intake, normalized protein catabolic rate (nPCR), and malnutrition inflammation score (MIS), were measured at baseline. Fifty-three patients died during the study. Survivors had significantly higher nPCR (1.10 ± 0.24 g/kg/day vs. 1.01 ± 0.21 g/kg/day; p = 0.048), energy intake (26.7 ± 5.8 kcal/kg vs. 24.3 ± 4.2 kcal/kg; p = 0.009) and protein intake (0.91 ± 0.21 g/kg vs. 0.82 ± 0.24 g/kg; p = 0.020), and lower MIS (5.2 ± 2.3 vs. 6.1 ± 2.1, p = 0.039). In multivariable analysis, energy intake <25 kcal/kg (HR 1.860, 95% CI 1.018–3.399; p = 0.044) and MIS > 5 (HR 2.146, 95% CI 1.173–3.928; p = 0.013) were independent variables associated with all-cause mortality. These results suggest that higher MIS and lower energy intake are harmful to ESRD patients on maintenance hemodialysis. Optimal energy intake could reduce mortality in these patients.
Highlights
Protein-energy wasting (PEW) is associated with an increased morbidity and mortality in patients undergoing maintenance hemodialysis for end stage renal disease (ESRD) [1]
PEW results from reduced dietary intake, inflammation, resistance to anabolic hormones, loss of nutrients during dialysis, and the breakdown of muscle protein induced by metabolic acidosis and comorbid conditions due to uremia [2]
A total of 168 ESRD patients on maintenance hemodialysis for at least three months were selected from the dialysis unit at Asan Medical Center (Seoul, Korea) during April 2006
Summary
Protein-energy wasting (PEW) is associated with an increased morbidity and mortality in patients undergoing maintenance hemodialysis for end stage renal disease (ESRD) [1]. PEW results from reduced dietary intake, inflammation, resistance to anabolic hormones, loss of nutrients during dialysis, and the breakdown of muscle protein induced by metabolic acidosis and comorbid conditions due to uremia [2]. A number of comorbid diseases and conditions are predictors of outcome [3], and contributors to PEW in ESRD patients [4]. The prevalence of PEW among maintenance hemodialysis patients varies from 30% to 75% [5,6,7]. The practice guidelines and criteria for evaluating the nutritional status in ESRD patients recommend the coordinated use of biochemical measures, body mass, muscle mass, dietary intake, and an integrative nutritional scoring [9,10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
