Prevalence Of Protein-energy Wasting Research Articles

Screening for protein energy wasting in children with chronic kidney disease using dual energy x-ray absorptiometry as an additional tool.

The current diagnosis of protein energy wasting (PEW) is based on scoring systems that lack precision in measuring muscle deficits. We undertook this cross-sectional study to determine the prevalence of PEW in children with chronic kidney disease (CKD) using a scoring system that included dual energy x-ray absorptiometry (DEXA) for measuring lean body mass (LBM) and to determine the prevalence of selected markers in PEW. Thirty CKD and 20 healthy children (1-18years) were evaluated for (1) reduced dietary protein intake (DPI); (2) BMI < fifth centile for height age (BMI/HA); (3) serum albumin < 3.8g/dl, cholesterol < 100mg/dl, or CRP > 3mg/L; (4) LBM < fifth centile for height age [LBMr] on DEXA. PEW was scored as minimal-one parameter positive in 2/4 categories; standard-one parameter positive in 3/4 categories; or modified-standard plus height < 2 SD. Twenty childrenwith CKD (66.7%) had PEW, (5/9) 55% in CKD 3, and (15/21) 71% in advanced CKD; minimal 12, standard 1, and modified 7. LBMr was seen in 20 (100%), reduced DPI in 16 (80%), and BMI/HA in 6 (30%) childrenwith PEW. LBMr had 100% sensitivity and BMI/HA 100% specificity. LBMr was seen in 8 who had no other criteria for PEW. None of the parameters were positive in controls (p < 0.01). PEW prevalence in CKD was high. Both prevalence and severity were higher in advanced CKD. LBMr was a highly sensitive marker to detect PEW. LBMr seen in some children with CKDwho were negative for other markers could represent subclinical PEW.

Protein energy wasting in pre-dialysis chronic kidney disease patients in Benin City, Nigeria: A cross-sectional study.

Protein energy wasting (PEW) is common among chronic kidney disease (CKD) patients, especially those with advanced stage. It worsens frailty, sarcopenia and debility in CKD patients. Despite the importance of PEW, it is not routinely assessed during management of CKD patients in Nigeria. The prevalence of PEW and its associated factors were determined in pre-dialysis CKD patients. This was a cross-sectional study that involved 250 pre-dialysis CKD patients and 125 age- and sex- matched healthy controls. Body mass index (BMI), subjective global assessment (SGA) scores and serum albumin levels were used in PEW assessment. The factors associated with PEW were identified. P-value of < 0.05 was taken as significant. The mean age of CKD and control group were 52.3±16.0 years and 50.5±16.0 years, respectively. The prevalence of low BMI, hypoalbuminaemia and malnutrition defined by SGA in pre-dialysis CKD patients were 42.4%, 62.0% and 74.8%, respectively. The overall prevalence of PEW among the pre-dialysis CKD patients was 33.3%. On multiple logistic regression, the factors associated with PEW in CKD were being middle aged (adjusted odds ratio: 12.50; confidence interval: 3.42-45.00; p <0.001), depression (adjusted odds ratio: 2.34; confidence interval: 1.02-5.40; p = 0.046) and CKD stage 5 (adjusted odds ratio: 12.83; confidence interval: 3.53-46.60; p <0.001). PEW is common in pre-dialysis CKD patients and it was associated with middle age, depression and advanced CKD. Early intervention aimed at addressing depression in early stages of CKD may prevent PEW and improve overall outcome in CKD patients.

Correlation between serum trimethylamine-N-oxide concentration and protein energy wasting in patients on maintenance hemodialysis

Objectives Chronic kidney disease (CKD) is a serious health problem that is associated with several systemic changes, including protein energy wasting (PEW). However, the exact mechanism of PEW in CKD remains unclear. As one of the important intestinal flora metabolites and uremic toxins, trimethylamine-N-oxide (TMAO) is involved in CKD-associated mortality, which might play a role in the development of PEW in CKD patients especially in patients on maintenance hemodialysis (MHD). However, this possibility has not been investigated. Methods PEW was diagnosed in a group of CKD patients on MHD according to the criteria of the International Society of Renal Nutrition and Metabolism. Serum TMAO concentration was assessed by high-performance liquid chromatography and mass spectrometry. The association between TMAO concentration and PEW was assessed using linear regression and logistic analysis after adjustment for confounding factors, including basic characteristics, comorbidities, and laboratory findings. Results The circulating TMAO level was higher in the MHD patients than in control (healthy) individuals (5653.76 ± 2853.51 vs. 254.92 ± 197.88 ng/mL, p < 0.001). Further, after the MHD patients were screened for PEW, those with PEW were found to have significantly higher serum TMAO levels than those without PEW (6760.9 vs. 4016.1 ng/mL, p < 0.001). Further, the serum TMAO concentration exhibited a significant negative correlation with body mass index (BMI) and dietary protein intake. In the logistic regression analysis, after adjustment for confounding factors, the serum TMAO concentration was still significantly correlated with PEW occurrence. Conclusions The circulating TMAO level is significantly correlated with the prevalence of PEW in MHD patients. TMAO might be a potential target in the prevention and treatment of PEW in CKD especially ESRD.

Nutritional Predictors of Mortality after 10 Years of Follow-Up in Patients with Chronic Kidney Disease at a Multidisciplinary Unit of Advanced Chronic Kidney Disease.

Nutritional monitoring in advanced chronic kidney disease (ACKD) units provides personalized care and improves clinical outcomes. This study aimed to identify mortality risk factors in chronic kidney disease (CKD) patients on nutritional follow-up in the multidisciplinary ACKD unit. A retrospective cross-sectional observational study was conducted in 307 CKD patients’ stage 3b, 4–5 followed-up for 10 years. Clinical and nutritional monitoring was performed by malnutrition-inflammation score (MIS), biochemical parameters (s-albumin, s-prealbumin, and serum C-reactive protein (s-CRP), body composition measured by bioelectrical impedance analysis (BIA), anthropometry, and handgrip strength measurements. The sample was classified into non-survivors, survivors, and censored groups. Of the 307 CKD patients, the prevalence of protein-energy wasting (PEW) was 27.0% using MIS > 5 points, s-CRP > 1 mg/dL was 19.20%, and 27.18% died. Survivors had higher significant body cell mass (BCM%) and phase angle (PA). Survival analyses significantly showed that age > 72 years, MIS > 5 points, s-prealbumin ≤ 30 mg/dL, PA ≤ 4°, and gender-adjusted handgrip strength (HGS) were associated with an increased risk of mortality. By univariate and multivariate Cox regression, time on follow-up (HR:0.97), s-prealbumin (HR:0.94), and right handgrip strength (HR:0.96) were independent predictors of mortality risk at 10 years of follow-up in the ACKD unit. Nutritional monitoring in patients with stage 3b, 4–5 CKD helps to identify and treat nutritional risk early and improve adverse mortality prognosis.

Anemia, overhydration, and lower muscle strength in hemodialysis patients with protein-energy wasting.

The protein-energy wasting (PEW) syndrome is a common complication in hemodialysis (HD) patients associated to morbidity and mortality. Our objective was to assess the prevalence of PEW and its association with erythropoietin resistance index (ERI) score, body composition by impedance, health-related quality of life, and muscle strength. In this cross-sectional, observational, multicenter study, we included data from 191 HD patients from three HD clinics located in Mexico City, Mexico. Clinical and biochemistry variables, body composition, handgrip strength, and the KDQOL-SF36 questionnaire were collected for each patient. Prevalence of PEW was 22% (n=41/191), with a higher frequency in those with diabetes mellitus (59% vs. 49%, p=0.04). Subjects with PEW had lower hemoglobin levels (9.5 + 1.6g/dl vs. 10.3 + 1.7g/dl; p=0.005) and higher ERI scores (19.2 ± 11.2 vs. 15.6 ± 8.2; p=0.04) compared with the non-PEW group. In analysis of body composition, PEW was associated to higher overhydration status (42.2 vs. 24.9 OH/kg; p=0.009), higher extracellular water (263 ± 40 vs. 246 ± 32 ml/kg; p =0.019), lower lean tissue index (12.2 ± 3.2 vs. 14.1 ± 3.7ml/m2 ; p=0.021), and lower fat tissue index (9.6 ± 5.7 vs. 12.3 ± 6.2ml/m2 ; p=0.043). Handgrip strength was lower in PEW patients (22.5 vs. 28.1kg; p=0.002). Finally, no significant differences were observed between groups in quality-of-life assessment. In this study, PEW was associated to poor responsiveness to erythropoiesis-stimulating agents, lower muscle strength, and higher overhydration status due to the increase in extracellular water which replaced the loss of tissue. Nevertheless, quality-of-life assessment was not different in patients with PEW compared with those without this complication.

Nutrition and quality of life in chronic kidney disease patients: a practical approach for salt restriction.

The clinical practice guidelines (CPGs) for nutrition in chronic kidney disease (CKD) were updated after 20 years from the previous guidelines by the Kidney Disease Outcomes Quality Initiative (KDOQI). During this period, the severity of CKD was defined by eGFR and albuminuria by the organization Kidney Disease: Improving Global Outcomes (KDIGO). Main risk factors for CKD such as hypertension, hyperlipidemia, obesity, metabolic syndrome, and diabetes mellitus are closely related to lifestyle. Nutritional management is important to prevent and retard the progression of CKD. Members of the International Society of Renal Nutrition and Metabolism (ISRNM) reviewed the KDOQI CPG draft. ISRNM is an international scientific society comprising members of multiple subspecialties. ISRNM proposed the medical term protein-energy wasting (PEW), which is a keyword in renal nutrition. The prevalence of PEW among dialysis patients is high. The success of dietary therapy depends on adherence to the diet. It has to be palatable, otherwise eating habits will not change. To prevent the development and progression of CKD and PEW, regular consultation with an expert dietitian is required, especially regarding salt and protein restriction. Our cluster-randomized trial showed that intervention by a dietician was effective at retarding the progression of stage 3 CKD. In this review, I focus on salt (sodium) restriction and introduce tips for salt restriction and Japanese kidney-friendly recipes. Due to the lack of randomized controlled trials, nutritional management of CKD inevitably relies on expert opinion. In this regard, well-designed observational studies are needed. Too strict salt restriction may decrease quality of life and result in PEW.

Low Prevalence of Protein Energy Wasting in Advanced Chronic Kidney Disease Patients Managed with a Nutritional Monitoring Program

Low Prevalence of Protein Energy Wasting in Advanced Chronic Kidney Disease Patients Managed with a Nutritional Monitoring Program

MO601THE ASSESSMENT OF NUTRITIONAL STATUS AND MORTALITY IN GERIATRIC PATIENTS WITH CKD 3B-5 STAGES

Abstract Background and Aims:. the prevalence of chronic kidney disease (CKD) increases with age–almost 50% of people over the age of 70 have stage 3-5 CKD. Geriatric patients with pre-dialysis stages of CKD are recommended to assess the risk of absolute probability of death of the patient both in the case of starting dialysis and without it. Malnutrition in this group of patients is the risk factor of mortality. The EQUAL study, a European Quality Study on treatment in advanced chronic kidney disease, showed that according to the Subjective Global Assessment Scale the majority of the geriatric patients with with incident glomerular filtration rate &amp;lt;20mL/min/1.73m 2 (nondialysis) had a normal nutritional status (SGA 6-7), 26% had moderate PEW (SGA 3-5), and less than 1% had severe PEW (SGA 1-2). The aim is to assess prevalence of protein-energy wasting (PEW) and the absolute risk of death over 5 years in the geriatric patients with advanced chronic kidney disease (CKD). Method Materials and methods: a study of 151 geriatric patients with stage 3B-5 CKD, average age 77 ±8.6. Patient inclusion criteria: age 60-90 years, CKD stage 3B-5 (GFR in CKD-EPI &amp;lt;= 45 ml / min / 1.73 m2. Patient exclusion criteria: oncological diseases; acute infections; severe mental illness (including alcoholism), any serious somatic diseases, according to the researcher. The patients were assessed by Subjective Global Assessment; to assess the estimated 5-year mortality rate, patient indicators were evaluated on the Banzal scale. All patients were evaluated for laboratory data (absolute number of lymphocytes, hemoglobin, red blood cells, creatinine, urea, total protein, blood albumin, total cholesterol, blood potassium, and proteinuria); The study group consisted of 105 patients with stage 3B CKD, 35 patients with stage 4 CKD, and 11 patients with stage 5 CKD. Results according to the SGA 66,7% of patients with CKD 3b stage have normal nutritional status, 26,6% patients are mild to moderate malnourishment, 6,7 % are malnourished. 60% of patients with CKD 4 stage have normal nutritional status, 31,2% patients had moderate PEW, 8,8% had severe PEW. In patients with CKD 5 72,7% had moderate PEW, 27,3% had severe PEW. The level of total protein in the blood serum is correlated with nutritional disorders on the SGA scale(r=-0.52) in geriatric patients with predialysis stages of CKD. During assessing the absolute risk of death within 5 years (Bansal Score) in 20.9% of patients with CKD3B, the estimated mortality rate was 40%, in 12.4% 54%, in 25.7% 69% and higher. All patients with stage 5 CKD had a mortality risk of 40% or higher. Indicators of the the Bansal scale significantly increased with a decrease in GFR (r= - 0.68, r=-0.46). The Banzal mortality index (r=0.32) significantly increased with increasing the level of serum phosphorus and uremia. Conclusion. The prevalence of nutritional disorders are observed in 33-40% of elderly patients with stage 3B-4 CKD and until 75% with stage 5CKD. During assessing the absolute risk of death over 5 years in the study population of geriatric patients with CKD stages 3B-5, a high risk on the Bansal scale (69% or higher) was observed in 25.7% with CKD stage 3B, 60%

Protein-Energy Wasting and Mortality Risk Prediction Among Peritoneal Dialysis Patients

Protein-energy wasting (PEW) is defined as the loss of body protein and energy reserves associated with kidney disease. However, the extent to which PEW contributes to increased mortality among peritoneal dialysis (PD) patients remains unclear. This is a retrospective cohort study from 2012 to 2020. The PEW was diagnosed by applying at least 3 of the 4 following criteria: (1) altered serum biochemistry indicated by a serum albumin level of <3.5g/L; (2) decreased body mass status identified by a body mass index (BMI) of <23kg/m2 or <10% total body fat; (3) muscle wasting defined by the lean tissue index, calculated as a lean tissue mass normalized to the height-squared in the <10th percentile of the reference population; and (4) low dietary protein intake determined by the normalized protein equivalent of a total nitrogen appearance of <0.8g/kg/day. The Malnutrition Inflammation Score (MIS) was also examined as an alternative tool for assessment of PEW. The average age of the 555 participants was 57.5±12.6years. The prevalence of PEW was 27.3%, with 196 deaths observed during the mean follow-up of 25.5months. Patients with PEW who fulfilled at least 3 of the 4 listed criteria had a higher risk of death in the unadjusted model (hazard ratio 1.61, 95% confidence interval 1.19-2.18, P=.002). However, these associations were attenuated after adjusting for potential confounders. Regarding the individual PEW criterion, decreased serum albumin and low muscle mass were significantly associated with mortality in the multivariable models. In contrast, decreased body mass and low protein intake were not associated with a higher risk of death. High MIS (≥5 points) and each one-point increase in the MIS were also significantly associated with higher risk of death in both unadjusted and adjusted models. Among PD patients, the presence of PEW was not a better predictor of all-cause mortality than either the altered serum biochemistry (albumin) or low muscle mass criteria. The MIS performed well as an independent predictor of death and might be an option for assessment of PEW status in the PD population.

An approach to the application of glim diagnostic criteria in hemodialysis patients

Rationale: Protein-energy wasting (PEW) is a syndrome characterized by malnutrition related to disease and inflammation in hemodialysis (HD) patients. This study aimed to analyse the prevalence of PEW by applying Glim's diagnostic criteria and the contribution of other nutritional-inflammatory biomarkers in HD patients.

&lt;p&gt;Protein-Energy Wasting and Associated Factors Among Chronic Kidney Disease Patients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia&lt;/p&gt;

BackgroundProtein-energy wasting is a major issue in patients with chronic kidney disease (CKD), adversely affecting morbidity, mortality, functional activity, and quality of life. Assessment of nutritional status in CKD patients is important to ensure patient’s normal protein stores and avoid metabolic complications. However, in Ethiopia, there were very few studies done to assess the prevalence of protein-energy wasting (PEW) and its associated factors among CKD patients.ObjectiveTo assess protein-energy wasting and associated factors among chronic kidney disease patients at adult OPD St. Paulo’s Hospital Millennium Medical College, Addis Ababa Ethiopia.Materials and MethodsAn institution-based cross-sectional study was conducted from March to April 2019. Data were collected using a structured interviewer-administered questionnaire and anthropometric measurements, and laboratory data were collected from patient files. Data were entered into Epi-data version 3.1 and analyzed using SPSS version 20. Both bivariate and multiple logistic regression analyses were performed to identify associated factors. P values <0.05 were considered to declare statistical significance.ResultsIn this study, 274 respondents were interviewed with a response rate of 100%. The prevalence of protein-energy wasting in CKD patients was 23.4%. Chronic kidney disease patients at age ≥65 years were seven times more likely to have protein-energy wasting as compared to patients aged 18–34 years [AOR=7.0, 95% (CI: 2.4, 20.5)]. Patients who had a history of anorexia were 5.2 times more likely to have protein-energy wasting as compared to those who had no history of anorexia [(AOR=5.2, 95% (CI: 2.7, 10.3)] and were significantly associated with the risk of having CKD.ConclusionThe prevalence of protein-energy wasting among CKD patients was high and associated with age, physical activity, history of anorexia, and CKD stages. Interventions that address nutritional problems and lifestyle factors in CKD patients need to be implemented together with medical treatment.

P1579PREVALENCE OF PROTEIN-ENERGY WASTING IN HEMODIALYSIS PATIENTS IN THE EUROPEAN REGION OF THE RUSSIAN FEDERATION

Abstract Background and Aims One of the complications of hemodialysis therapy (HD) is the development of protein-energy wasting (PEW), which is an independent predictor of morbidity and mortality in this cohort of patients. The prevalence of PEW in hemodialysis patients in different regions of the world varies from 15% to 75% but has not been practically studied in the Russian Federation. To assess the prevalence of protein-energy wasting in hemodialysis patients in the European region of the Russian Federation. Method 645 hemodialysis patients were examined in 9 hemodialysis centers in 5 regions of the European part of the Russian Federation. Among the patients there were 345 women and 300 men, the average age was 56.8 ± 12.8 years. The duration of hemodialysis therapy was 8.4 ± 5.3 years. The diagnosis of PEW was established in accordance with the criteria: biochemical criteria (serum albumin &amp;lt; 3.8 g per 100 ml; serum prealbumin (transthyretin) &amp;lt; 30 mg per 100 ml; serum cholesterol &amp;lt; 100 mg per 100 ml); low body weight, reduced total body fat, or weight loss; a decrease in muscle mass; and low protein or energy intakes. The level of blood albumin was determined using the BCG method (bromocresol green). Estimation of protein and calorie intake was performed using 3-day food diaries filled out by patients. Results Insufficient protein intake according to the International Society of Renal Nutrition and Metabolism (ISRNM) recommendations was observed in 5.5 % of patients, calories in 4.1 %, combined deficiency in protein and calorie intake in 2.7% of patients. The prevalence of PEW was 51.2 %. The relationship between age and gender was not identified. The lowest prevalence of PEW is observed in patients with a hemodialysis therapy experience of fewer than 5 years (25,4 %) and gradually increasing by 2.5 times in patients with survival rates on HD for more than 10 years (χ2 = 22,580 р = 0.0001). Conclusion The prevalence of protein-energy wasting in hemodialysis patients in the European region of the Russian Federation is 51,2 %.

Relationship between protein-energy wasting in adults with chronic hemodialysis and the response to treatment with erythropoietin

BackgroundIt is known that one of the leading causes of morbidity in chronic kidney disease (CKD) is the anemic syndrome. Although the pathogenic mechanisms of anemia are multiple, erythropoietin deficiency appears as the dominant factor. Patients in hemodialysis (HD) have a high prevalence of protein energy wasting (PEW) that may explains the poor response to Erythropoietin (EPO).MethodsRetrospective cohort study of patients on HD from January to December 2014. The participants were classified according to a diagnostic of PEW using the “Malnutrition Inflammation Score” (MIS) and bioimpedance analysis (BIA) measurement of body composition at the start of erythropoietin therapy and after 3 months of follow up. We performed descriptive statistics and analyzed the differences between groups with and without PEW considering their responsiveness. In addition, we calculated the relative risk of EPO resistance, considering p value < 0.05 as statistically significant.ResultsSixty-one patients ended the follow up. Both groups were similar in basal hemoglobin, hematocrit and other hematopoiesis markers (p = NS). Patients without PEW have a decrease risk for poor response to treatment with EPO (RR = 0.562 [95% CI, 0.329–0.961-]) than those with PEW. Finally, hemoglobin concentrations were evaluated at baseline and every four weeks until week 12, finding a statistically significant improvement only in patients without PEW according MIS (p < 0.05).ConclusionsPEW is an incremental predictor of poor responsiveness to EPO in HD patients, thus, it is important to consider correcting malnutrition or wasting for a favorable response to treatment with EPO.

MON-119 APPLICATION OF GENDER SPECIFIC ULTRASONOGRAPHY CUT-OFFS TO DETERMINE RISK OF PROTEIN ENERGY WASTING IN HEMODIALYSIS PATIENTS

Muscle depletion in hemodialysis (HD) patients associates with protein energy wasting (PEW) but quantification of muscle mass is challenging in the outpatient HD setting. Quadriceps muscle thickness assessment by ultrasound imaging (UI) offers a potential surrogate measure for muscle mass, and we aimed to determine the applicability of gender specific UI cut-off values for identifying risk of PEW in HD patients. PEW risk assessment used the criteria set by International Society of Renal Nutrition and Metabolism (ISRNM), namely body mass index (BMI) <23 kg/m2, reduction >10% in mid-arm muscle circumference (MAMC) in relation to the 50th percentile of reference population, serum albumin <38 g/dL and dietary energy intake (DEI) <25 kcal/kg ideal body weight (IBW). Using a portable UI device, we measured the cross-sectional area of the quadriceps muscle namely rectus femoris (RFCSA) in 351 Malaysian HD patients participated in the on going multi-centered Palm Tocotrienol in Chronic Hemodialysis (PaTCH) screening study. Using receiving operating characteristic analysis, derived RFCSA cut-off values to identify patients at risk of PEW were <6.00 cm2 for men and <4.47 cm2 for women. Differences for PEW criteria and various nutritional parameters were examined based on gender specific categorization (men: <6.00cm2 vs >6.00cm2 and women: <4.47cm2 vs >4.47cm2). Mann-Whitney’s U tested continuous data while Chi-square tested categorical data. Both men (62%, p<0.001) and women (77%, p=0.003) with smaller RFCSA had a higher prevalence of PEW. As per PEW criteria, both men and women with smaller RFCSA had significantly poorer BMI (men: 21.08, IQR: 19.11-23.74kg/m2 vs 25.10, IQR: 22.96-27.50kg/m2, p<0.001; women: 20.54, IQR: 18.29-22.85 kg/m2 vs 25.49, IQR: 22.83-28.85 kg/m2, p<0.001) and MAMC (men: 22.74, IQR: 20.41-24.75cm vs 24.76, IQR: 23.58-26.36cm, p<0.001; women: 19.38 IQR: 17.73-22.45cm vs 23.57, IQR: 21.34-25.39cm, p<0.001). DEI was significantly lower only in men with RFCSA<6.00cm2 (22.53, IQR: 19.09-27.66kcal/kg IBW vs 25.67, IQR: 22.46-30.43kcal/kg IBW, p<0.001) but not in women (23.64, IQR: 20.16-29.34kcal/kg IBW vs 24.35, IQR: 20.90-28.18kcal/kg IBW, p>0.05). Irrespective of gender, significantly lower muscle and fat mass, handgrip strength, and higher Malnutrition-Inflammation Score (all p<0.05) were observed in patients with smaller RFCSA. Using gender-specific RFCSA cut-offs, the UI method enabled differential PEW identification based on ISRNM criteria, yet factoring heterogeneous body compositional differences mediated by gender.

MON-305 CROSS-SECTIONAL STUDY OF NUTRITIONAL STATUS AND FRAILTY IN ELDERLY PATIENTS ON MAINTENANCE HEMODIALYSIS

The population in Kazakhstan is rapidly aging, as a result the number of geriatric patients on maintenance hemodialysis (MHD) has been increasing. Protein-energy wasting (PEW) is one of the common complications that can lead to infections, cardiovascular diseases, frailty, and increased morbidity and mortality in these patients. The primary objectives of this study were to evaluate the prevalence of PEW in elderly patients on MHD by using two different nutritional assessment tools and assess their association with clinical and laboratory measurements.

Influencing factors of protein energy wasting in maintenance hemodialysis patients

Objective: To analyze the influencing factors of protein energy wasting (PEW) in maintenance hemodialysis (MHD) patients. Methods: A multicenter cross-sectional study was conducted in eleven hemodialysis centers of Guizhou province between June and August 2018. Clinical data, physical parameters, body composition data and laboratory values of MHD patients were collected. Analysis of variance was used to assess the impact of the indicators on the prevalence of PEW. Factor analysis was carried out after further classifing the factors into several common factors, and logistic regression was used to analyze the impact of common factors on PEW. Results: The results of univariate analysis showed that somatic cell mass, lean weight, fat content, body mass index (BMI), grip strength, leg circumference, hip circumference, waist circumference, midpoint circumference of upper arm, triceps skin fold thickness, hemoglobin, albumin, prealbumin, serum calcium, phosphorus, serum magnesium, creatinine, parathyroid hormone were the influential factors of PEW (all P<0.05). Factor analysis indicated that the above indicators can be classified into five common factors. Logistic regression model showed that with the increase of the prevalence of PEW, the scores of common factors decreased, the absolute value of regression coefficient beta in sequence, was common factor 2 (β=-2.258, P<0.001), common factor 4 (β=-1.589, P<0.001), common factor 1 (β=-1.144, P=0.001) and common factor 3 (β=-0.740, P=0.016). Conclusion: The reduction of fat content, anemia, hypoproteinemia, disorder of calcium and phosphorus metabolism were important factors influencing PEW.

Combating protein energy wasting in end stage kidney disease: role of exogenous proteolytic enzyme as an adjuvant to dietary protein

Background: Despite interventions, the prevalence of protein energy wasting in patients on dialysis continues to be unacceptably high. The objective of the study is to evaluate the efficacy of exogenous proteolytic enzyme, as an adjuvant to dietary protein in improving the nutritional status.Methods: This is a retrospective, real world, single centre, observational study, aimed at assessing the changes in key nutritional indices, over 6 months in patients with chronic kidney disease (CKD) initiated on continuous ambulatory peritoneal dialysis (CAPD). The intervention included addition of egg protein and use of an exogenous proteolytic enzyme. Three cohorts were identified. Cohort 1, had access to a nephrologist and CAPD counsellor; Cohort 2, in addition had access to a dietician who emphasized the need for increase in dietary protein in form of 4-6 eggs a day; and cohort 3, were in addition given an exogenous proteolytic enzyme with the major protein meal.Results: The absolute fall in serum albumin at 6 months for the cohort 1, 2 and 3 is 0.48, 0.29 and 0.09 gm/dl respectively. Not only was the fall in serum albumin significantly less with the use of exogenous proteolytic enzyme, a higher proportion of patients were able to maintain or improve their serum albumin. The fall in midarm circumference was maximum in cohort 1 (2.08 cm) and least in cohort 3 (0.45 cm). This positive trend however, did not achieve statistical significance.Conclusions: Use of exogenous proteolytic enzyme, when combined with egg protein, improves key nutritional indices in patients of CKD on CAPD.

MTOR and indicators of sarcopenia in patients with chronic kidney disease receiving hemodialysis treatment

The aim : to assess the prevalence of protein-energy wasting (PEW) and reduction of muscle strength in patients with chronic kidney disease C5D stage (CKD5D), and to determine the role of mTOR in the processes of protein degradation and the development of sarcopenia in the studied group. Patients and methods : The study included 80 patients with CKD5D (47 men and 33 women) receiving hemodialysis treatment. The average age was 51.7 ± 11.6 years. All patients underwent dynamic dy-namometry, bioimpedancemetry, and determination of the level of mTOR (“ELISA Kit”, USA) in the blood serum using an open enzyme immunoassay. Results: The prevalence of PEW (according to Bilbrey, Cohen) in the group was 91.5% in men and 87.9 % in women. A decrease in muscle strength was found in 12.8 % of men and in 27.3 % of women. A statistically significant relationship was found between the mTOR level and the “dry weight,” basal metabolism, fluctuation of the dose of iron, average monthly dose of iron. A weak direct correlation between muscle strength and daily caloric intake of food (r = 0.22, p&lt;0.05) was revealed. Conclusion : Our data were confirm the involvement of mTOR in the activation of catabolic processes in patients with CKD5D and the development of sarcopenia, clinically manifested by a decrease in muscle strength. mTOR can be considered as a promising prognostic molecular marker in assessing the risk of sarcopenia in patients with CKD5D.

Association of platelet/lymphocyte ratio and neutrophil/lymphocyte ratio with protein-energy wasting in maintenance hemodialysis patients

Objective: To explore the association of platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) with protein energy wasting (PEW) in maintenance hemodialysis (MHD) patients. Methods: A multicenter cross-sectional study was conducted in eleven hemodialysis centers of Guizhou province from June to August, 2017. Clinical data, physical parameters, body composition data and laboratory values of MHD patients were collected. PLR and NLR were calculated according to routine blood test. All patients were divided into four groups (Q1-Q4) according to the median and quartile of PLR and NLR. Multivariate logistic regression models were applied to analyze the relationships between PLR, NLR and PEW. The comparison of predictive power of PLR and NLR for PEW was evaluated by receiver operating characteristic curve (ROC). Results: A total of 936 MHD patients were enrolled (519 males, 417 females), with a mean age of (55.6±15.6) years. The prevalence of PEW was 46.2% (432/936). Multivariate logistic regression analysis showed that patients in group PLR Q3 and Q4 were 2.07 (95%CI: 1.03-4.13, P=0.014) and 2.73 (95%CI: 1.58-4.74, P<0.001) times more likely to have PEW, compared with those in group PLR Q1 in unadjusted models. PLR was significantly associated with the development of PEW after adjusting age, sex, history of hypertension, diabetes and hemoglobin. Patients in Group PLR Q3 and Q4 were 2.82 times (95%CI: 1.42-5.60, P=0.003) and 2.93 times (95%CI: 1.50-5.73, P=0.002) times more likely to have PEW than those in Group PLR Q1. The ROC showed that only PLR can predict the development of PEW with a diagnostic threshold of 144.09 [area under curve (AUC)=0.61, 95%CI: 0.56-0.66, P<0.001], with a sensitivity and specificity of 61% and 58%, respectively, while the AUC of NLR is 0.55 (P=0.091). Conclusion: For MHD patients, only PLR could be a relevent factor of PEW and it showed the predictive power of PEW rather than NLR.

Nutritional status using ISRNM criteria and MIS of chronic haemodialysis patients at Sanjiwani Gianyar General Hospital

Protein energy wasting (PEW) are common in patients with chronic kidney disease (CKD), especially in patientson chronic dialysis therapy. This cross-sectional descriptive analytic study aims to examine the prevalent of PEW based on The International Society of Renal Nutrition and Metabolism criteria (ISRNM): (anthropometric measurement (BMI = Body Mass Index), biochemical measurement (serum albumin), and muscle mass (mid upper-arm circumference) and Malnutrition Inflammation Score (MIS) tools in calculating prevalent of PEW among haemodialysis patients.This study recruited 71 chronic haemodialysis patients at Sanjiwani Gianyar General Hospital composed of 51 maleand 20 female, mean of age is 49.7± 14.7 and most patients (69%) with permanent access AV shunt. Based on The ISRNM criteria of PEW, this study exhibited PEW whilst 66.2% (BMI less than 23 kg/m2, serum albumin concentration less than 3.8 g/dl, and mid upper-arm circumference less than 25.5 cm) and 69% patient were malnourished on MIS more than equal to 5 score, respectively. Conclusions: prevalence of PEW in chronic HD patients at Sanjiwani Gianyar General Hospital is high according to ISRNM criteria and MIS. And PEW based on ISRNM criteria were consistently to MIS with kappa 0.468; p<0,001.