Risk Of Protein-energy Wasting Research Articles

Phase angle is a useful predicting indicator for protein-energy wasting and cardiovascular risk among maintenance hemodialysis patients.

Protein-energy wasting (PEW) is a major contributor to the high mortality among maintenance hemodialysis (MHD) patients. Cardiovascular disease (CVD) is the leading cause of death in dialysis patients, and PEW can significantly increase cardiovascular mortality in MHD patients. Previous studies have confirmed that PA may be a good objective indicator for determining the nutritional status and prognosis of MHD patients. Our study aimed to determine the predictive value of phase angle (PA) as detected by bioelectrical impedance analysis (BIA) on PEW and cardiovascular (CV) risk among MHD patients. Our retrospective observational study involved 161 adult patients with HD. The Cardiovascular risk score is a risk model based on the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS). We established LASSO logistic regression analysis model to identify key parameters related to body composition that can predict PEW in MHD patients. The area under the curve (AUC) values for PA, appendicular skeletal muscle mass index (ASMI), body cell mass (BCM), and mid-arm circumference (MAC) in predicting PEW in male MHD patients were relatively large, with 0.708, 0.674, 0.663, and 0.735, respectively. The predicted PEW values of these parameters were slightly lower in female patients than in men. We incorporated PA, ASMI, BCM, and MAC into a model that predicted the incidence of PEW in maintenance hemodialysis patients using LASSO technology. We discovered that the model predicted a greater AUC of PEW occurrence than any single factor, 0.877 for men and 0.76 for women. The results of the univariate logistic regression analysis showed that the low PA tertile array group had a greater incidence of PEW than the high PA group (P < 0.001). Additionally, we also found that lower PA was associated with higher CV risk scores. The PA detected by bioelectrical impedance analysis could predict the risk of PEW and cardiovascular events among patients with MHD. When used in conjunction, PA, ASMI, BCM, and MAC have a high diagnostic efficacy for PEW in patients on maintenance hemodialysis.

Association between pro-vegetarian dietary pattern and the risk of protein-energy wasting and sarcopenia in patients with chronic kidney disease

BackgroundChronic kidney disease (CKD) is characterized by structural abnormalities in nephrons, loss of functional nephrons, and impaired renal excretory function. A pro-vegetarian dietary pattern (PDP) is a gradual and progressive approach to vegetarianism. The current study aimed to assess the association between PDP and the odds of protein-energy wasting (PEW) and sarcopenia in patients with CKD.MethodsThe present cross-sectional study was conducted on kidney disease patients (n = 109) referred to two clinics in Shiraz, Iran. The diagnosis of sarcopenia and PEW was made according to the guidelines of the Asian Working Group for Sarcopenia (AWGS) and the International Society of Renal Nutrition and Metabolism (ISRNM) criteria, respectively. The participants’ dietary intake was evaluated using a 168-item semi-quantitative food frequency questionnaire (FFQ). For PDP index calculation, plant and animal food sources were categorized into 12 subgroups. The association between sarcopenia and PEW with PDP was evaluated using logistic regression.ResultsThe PDP was significantly associated with a lower risk of PEW in the second tertile compared to the first in the crude model (odds ratio (OR) = 0.225; confidence interval (CI): 0.055–0.915; p-value = 0.037). After adjusting for potential confounders, lower significant odds of PEW were observed in the second and last tertiles of PDP compared to the first (T2: OR = 0.194; CI: 0.039–0.962; p-value = 0.045, and T3: OR = 0.168; CI: 0.030–0.950; p-value = 0.044). In contrast, no significant relationship was observed between PDP and the odds of sarcopenia (p-value ˃ 0.05).ConclusionsOverall, the findings indicated that greater adherence to PDP was negatively associated with the odds of PEW. Additionally, the results showed no association between PDP and the odds of sarcopenia. Further studies are needed to support these findings.

The role of ultra-processed food consumption in protein-energy wasting and sarcopenia development in patients with chronic kidney diseases

BackgroundThe effect of ultra-processed foods (UPFs) on chronic kidney disease (CKD) has been studied in some studies. The present study aimed to investigate the association between UPF consumption and the risk of protein-energy wasting (PEW) and sarcopenia in patients with CKD in the Iranian population.MethodsThe current cross-sectional study included 110 patients with CKD referred to two clinics in Shiraz, Iran. The International Society of Renal Nutrition and Metabolism (ISRNM) criteria and the Asian Working Group for Sarcopenia (AWGS) guideline were considered for the diagnosis of PEW and sarcopenia, respectively. The valid semi-quantitative food frequency questionnaire was used to assess participants' dietary intake. The logistic regression was used to examine the association of UPFs with PEW and sarcopenia.ResultsWe observed no significant association between sarcopenia and PEW with UPFs in the crude model. After adjusting for confounders, we observed a significantly higher odds of sarcopenia in the upper versus lower median of UPF intake (odds ratio (OR) = 3.59, 95% confidence interval (CI): 1.02–12.62, P = 0.046).ConclusionsOur findings suggest a positive relationship between UPF intake and sarcopenia among CKD patients. Therefore, reducing the intake of UPFs may decrease the odds of sarcopenia in patients suffering from CKD.

Interactive effects of vitamin D and serum uric acid concentration on protein-energy wasting in maintenance hemodialysis patients.

This study aimed to explore the influence of the interaction between vitamin D level and blood uric acid level on protein-energy wasting (PEW) in patients with Maintenance hemodialysis (MHD), in order to provide a solution for disease prevention. For this aim, a total of 150 patients with maintenance hemodialysis aged 30-79 years in a hospital were included in the study. The logistic regression model was used to analyze the relationship between vitamin D level, blood uric acid level and PEW, and the additive interaction was evaluated by calculating the relative excess risk ratio (RERI) attributive ratio (AP) and synergy index (S) of the interaction. Finally, the ROC curve was drawn to evaluate the diagnostic value of vitamin D level and blood uric acid level for PEW. In this study, the detection rate of PEW was 68%, low vitamin D level was 57.33%, and high blood uric acid level was 64.67%. Compared with non-low vitamin D levels, the PEW risk was OR=16.794, 95%CI: 4.973-60.356; Compared with those without high uric acid levels, the PEW risk was OR=7.599, 95%CI: 2.460-23.468. However, there was no multiplicative interaction between the two on PEW risk (OR=0.345, 95%CI: 0.060-1.983, P=0.233). In the additive interaction analysis, the PEW risk OR=43.992,95%CI: 12.795-151.253, higher than those with only high uric acid levels or only low vitamin D levels, the combination of the two had a summative interaction with PEW risk, with a RERI of 20.599 (95%CI: -26.158-67.356) API was 0.468 (-0.159-1.095) and S was 1.920 (0.569-6.483). In conclusion, both vitamin D deficiency and high uric acid levels were associated with an increased risk of PEW in MHD patients, and low vitamin D and high uric acid levels had a summative interaction with protein-energy expenditure risk.

Risk factors analysis of protein energy wasting in children with chronic kidney disease

Objective: To analyze the clinical characteristics and risk factors of protein energy wasting (PEW) in children with chronic kidney disease (CKD). Methods: Clinical data of 231 children with chronic kidney disease hospitalized in Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to January 2023 were retrospectively analyzed to explore the incidence of PEW. According to the diagnostic criteria of CKDPEW, they were divided into a CKDPEW group and a non PEW group. The comparison between the groups was performed by independent-sample t test and Chi-squared test, and the risk factors were analyzed by multivariate Logistic regression. Results: Among the 231 children, there were 138 males and 93 females, with a visiting age of 9.9 (7.9, 16.0) years; 6 cases were in stage 1, 14 cases in stage 2, 51 cases in stage 3, 36 cases in stage 4, and 124 cases in stage 5. A total of 30 children (13.0%) with CKD PEW were diagnosed at the age of 7. 1 (3.8, 13.2) years, including 1 case in stage 1, 1 case in stage 2, 5 cases in stage 3, 5 cases in stage 4, and 18 cases in stage 5. There were a total of 201 cases (87.0%) in the non PEW group, diagnosed at the age of 11.8 (8.5, 12.2) years, including 5 cases in stage 1, 13 cases in stage 2, 46 cases in stage 3, 31 cases in stage 4, and 106 cases in stage 5. The Chi-squared test and t test showed that the systolic blood pressure, diastolic blood pressure, birth weight and carbon dioxide binding capacity of the CKD PEW group were lower than those of the non PEW group ((109±22) vs. (120±20) mmHg (1 mmHg=0.133 kPa), (72±19) vs. (79±16) mmHg, (2.9±0.5) vs. (3.2±0.6) kg, (17±4) vs. (19±4) mmol/L,t=2.85, 2.14, 0.67, 2.63, all P<0.05). Multivariate logistic regression analysis showed that carbon dioxide binding capacity and birth weight were independent protective factors of CKDPEW in children (OR=0.81 and 0.36, 95%CI=0.73-0.90 and 0.17-0.77, respectively; both P<0.01); the risk of PEW in CKD children decreased by 0.187 times for every 1 mmol/L increment in carbon dioxide binding capacity, and 0.638 times for every 1 kg increment in birth weight. Conclusions: The incidence of protein energy expenditure in children with chronic kidney disease is lower than that in the previous researches. PEW can appear in CKD 1-2 stage, and attention should be paid to it in the early stage of CKD in clinical practice. Low birth weight CKD children are susceptible to PEW, and actively correcting metabolic acidosis can reduce the risk of CKDPEW.

Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease.

Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease.

POS-726 NOVEL EQUATIONS FOR ESTIMATING RESTING ENERGY EXPENDITURE IN PERITONEAL DIALYSIS PATIENTS

With the development of chronic kidney disease (CKD), the risk of protein-energy wasting is increasing. It is urgent to have a convenient method to assess energy expenditure accurately in these patients. However, besides the direct measurement, which is expensive and time-consuming, there is no resting energy expenditure (REE) equations focus on peritoneal dialysis patients. We aimed to develop and validate REE equations in peritoneal dialysis patients. This cross-sectional study enrolled 140 patients with peritoneal dialysis according to inclusion and exclusion criteria. After random sampling matched 1:1 by age, gender and dialysis duration, stepwise linear regression analysis was used to derive a new REE equation (eREEpd) according to actual REE (aREE) measured using indirect calorimetry in the development dataset. The eREEpd value was then validated with aREE in the validation dataset in terms of bias, precision, and accuracy. Bias was assessed as the difference between the estimated and measured REE values, precision was assessed as the absolute value of difference, and accuracy was assessed as the percentage of estimates that differed >20% from the measured REE (1- P20). The eREEpd equation: eREEpd (kcal) = (1 if male; 0 if female) × 144.08 − 5.8 × age (y) + 10.33 × weight (kg)+ 850.71 (R2 = 0.649). The bias, precision, and accuracy of the eREEpd equation were -11.3 (IQR: −195.7, 115.0) kcal, 22.2 (IQR:64.9, 249.3) kcal, and 20.3%, respectively with indirect calorimetry as the reference method. Besides, we found hemoglobin was an independent predictive factor of REE developed an REE equation using age, sex, weight, and hemoglobin data, as eREEpd_Hb (kcal) = (1 if male; 0 if female) × 172.16 − 4.87 × age (y) + 9.63 × weight (kg)-3.05×hemoglobin (g/L)+ 1180.04 (R2 = 0.673).The bias, precision, and accuracy (percentage of estimates that differed >20% from the measured REE) of the eREEpd_Hb equation were 31.5 (IQR: −174.3, 102.0) kcal, 120.8 (IQR:59.6, 239.2) kcal, and 18.6%, respectively with indirect calorimetry as the reference method. The REE equation using age, sex, weight with or without hemoglobin data could serve as a reliable tool for estimating REE in patients with peritoneal dialysis.

Can Overnutrition Lead to Wasting?—The Paradox of Diabetes Mellitus in End-Stage Renal Disease Treated with Maintenance Hemodialysis

Background: The population of end-stage renal disease (ESRD) patients with diabetes mellitus (DM) may be at increased risk of protein energy wasting (PEW). The aim of the study was to investigate the impact of DM on selected indicators of PEW in the ESRD population that was undergoing maintenance hemodialysis (MHD). Methods: A total of 515 MHD patients were divided into two subgroups with and without DM. The evaluation of diet composition, Charlson Comorbidity Index (CCI), SGA, and laboratory and BIS analyses were performed. All-cause and cardiovascular mortality was recorded. Results: DM patients had lower albumin (3.93 (3.61–4.20) vs. 4.10 (3.80–4.30) g/dL, p < 0.01), total cholesterol (158 (133–196) vs. 180 (148–206) mg/dL, p < 0.01), and creatinine (6.34 (5.08–7.33) vs. 7.12 (5.70–8.51) mg/dL, p < 0.05). SGA score (12.0 (10.0–15.0) vs. 11.0 (9.0–13.0) points, p < 0.001), BMI (27.9 (24.4–31.8) vs. 25.6 (22.9–28.8) kg/m2, p < 0.001), fat tissue index (15.0 (11.4–19.6) vs. 12.8 (9.6–16.0) %, p < 0.001), and overhydration (2.1 (1.2–4.1) vs. 1.8 (0.7, 2.7) L, p < 0.001) were higher in the DM group. Increased morbidity, reflected in the CCI and mortality—both all-cause and cardiovascular—were observed in DM patients. Conclusions: Hemodialysis recipients with DM experience overnutrition with a paradoxically higher predisposition to PEW, expressed by a higher SGA score and lower serum markers of nutrition. This population is also more comorbid and is at higher risk of death, including from cardiovascular causes.

Resting metabolic rate and its adjustments as predictors of risk protein-energy wasting in hemodialysis patients.

Background: The purpose of the present study was to explore the association between resting metabolic rate (RMR) and protein-energy wasting (PEW) risk in Chinese hemodialysis patients by age and gender subgroup.Methods: RMR and body composition (body cell mass (BCM) and fat mass) of 774 patients undergoing hemodialysis were estimated by bio-electrical impedance analysis (BIA). Anthropometric data were collected by a standard measurement protocol, and the upper arm muscle circumference (AMC) was calculated. Biochemical nutritional and dialysis parameters were obtained. Linear regression analysis was used to analyze the relationship among RMR, body composition and nutritional factors.Results: The mean age was 54.96 ± 15.78 years. RMR level in patients was 1463.0 (1240.5, 1669.0) kcal/d. In multiple linear regression models, BCM, left calf circumference (LCC), fat mass were the determinants association with RMR (P<0.001). Among the patients in the sample, 133 (17.2%) had been diagnosed with PEW per International Society of Renal Nutrition and Metabolism (ISRNM) criteria and 363 (46.9%) were being at risk PEW. The area under the receiver-operating characteristic curve (AUC) of RMR for predicting risk PEW was greater than RMR/BCM and RMR/body surface area (BSA). When the cutoff of RMR was 1481 kcal/d it had the higher sensitivity and specificity (82 and 42%), and the AUC was 0.68 in elderly maintenance hemodialysis (MHD) patients (P<0.001). After adjustment for potential confounders, lowest RMR quartile level (<1239) increased the risk of PEW (OR = 4.71, 95% CI: 1.33–16.64, P=0.016) in all patients.Conclusions: Older patients with PEW have a lower RMR reduction. RMR and RMR/BCM may play the role in objective screening to detect risk PEW in MHD patients, especially in males.

Association of Ultrasound-Derived Metrics of the Quadriceps Muscle with Protein Energy Wasting in Hemodialysis Patients: A Multicenter Cross-Sectional Study.

This study aimed to assess muscle wasting and risk of protein energy wasting (PEW) in hemodialysis (HD) patients using an ultrasound (US) imaging method. PEW was identified using the ISRNM criteria in 351 HD patients. Quadriceps muscle thickness of rectus femoris (RF) and vastus intermedius (VI) muscles and cross-sectional area (CSA) of the RF muscle (RFCSA) were measured using US and compared with other physical measures. Associations of US indices with PEW were determined by logistic regression. Irrespective of gender, PEW vs. non-PEW patients had smaller RF, VI muscles, and RFCSA (all p < 0.001). US muscle sites (all p < 0.001) discriminated PEW from non-PEW patients, but the RFCSA compared to bio-impedance spectroscopy had a greater area under the curve (AUC, 0.686 vs. 0.581), sensitivity (72.8% vs. 65.8%), and specificity (55.6% vs. 53.9%). AUC of the RFCSA was greatest for PEW risk in men (0.74, 95% CI: 0.66–0.82) and women (0.80, 95% CI: 0.70–0.90) (both p < 0.001). Gender-specific RFCSA values (men < 6.00 cm2; women < 4.47 cm2) indicated HD patients with smaller RFCSA were 8 times more likely to have PEW (AOR = 8.63, 95% CI: 4.80–15.50, p < 0.001). The US approach enabled discrimination of muscle wasting in HD patients with PEW. The RFCSA was identified as the best US site with gender-specific RFCSA values to associate with PEW risk, suggesting potential diagnostic criteria for muscle wasting.

Bioelectrical impedance analysis-derived phase angle as a determinant of protein-energy wasting and frailty in maintenance hemodialysis patients: retrospective cohort study

BackgroundPhase angle (PA), measured by bioelectrical impedance analysis (BIA) has been studied as indicator of nutritional status or muscle function in hemodialysis (HD) patients. It remains unclear if the phase angle is associated protein-energy wasting (PEW) or frailty, which are common complication in hemodialysis patients. The aim of this study is to determine whether BIA-derived PA is a marker of PEW or frailty in HD patients.MethodsThis retrospective observational study included 116 adult HD patients (35% female, 64 ± 12 years of age) in a single dialysis center. Patients were classified according to the PA quartiles into four groups; 1) first quartile: PA < 3.7°, 2) second quartile: PA 3.7–4.1°, 3) third quartile: PA 4.2–4.9°and 4) forth quartile: PA ≥ 5.0°. International Society of Renal Nutrition and Metabolism (ISRNM) criteria and Japanese version of Cardiovascular Health Study (J-CHS) criteria were used to identify PEW and frailty.ResultsThe lower PA group was associated with a greater risk of PEW (35% vs. 24% vs. 21% vs. 3%; p = 0.032), frailty (59% vs. 40% vs. 21% vs. 3%; p < 0.001). In multivariate logistic regression analysis, the first quartile group was at a significantly greater risk of both PEW and frailty compared with the fourth quartile group after adjusting for other confounding factors.ConclusionsLower PA was associated with a greater risk of PEW and frailty in HD patients.

Which Method Should Be Used to Assess Protein Intake in Peritoneal Dialysis Patients? Assessment of Agreement Between Protein Equivalent of Total Nitrogen Appearance and 24-Hour Dietary Recall

After dialysis initiation, a high protein diet is recommended due to significant nutrient losses through dialysate and increased risk of protein energy wasting. In peritoneal dialysis (PD) patients, protein intake can be assessed through different methods that have some advantages and limitations, which affect its use on routine care. The aim of this study is to evaluate the agreement between 2 different methods (24-hour dietary recall and PNA-protein equivalent of total nitrogen appearance) on estimating protein intake in PD patients. Patients on PD for at least 3months, aged 18years old or more, were enrolled. To estimate protein intake, 24-hour dietary recall and PNA was used. PNA was calculated from 24-hour urine on the same day of the 24-hour dietary recall. Fifty individuals on PD were included, mean age 55.7±16.2years, and body mass index 26.0±4.5kg/m2. The average energy consumption was 1788.79±504.40kcal/day, which corresponds to 26.81±9.11kcal/kg current body weight (BW)/day and 29.82±8.39kcal/kg ideal body weight (IBW)/day. The median of total daily and normalized protein intake estimated using dietary recall was 61.43 (45.28-87.40) g/day, 0.90 (0.58-1.22) g/kg current BW/day, and 1.04 (0.77-1.32) g/kg IBW/day, respectively. Daily protein intake estimated by PNA was 55.75 (48.27-67.74) g/day, protein intake normalized by current BW was 0.81 (0.72-0.99) g/kg and 0.92 (0.83-1.06) g/kg IBW/day. Bland-Altman analysis indicates no systematic bias for the assessment of total protein intake and normalized protein intake for current and ideal BW. Significant proportionality bias was observed for both evaluations, showing there is a dispersion of the values. Despite the absence of systematic bias in the Bland-Altman analysis, there is no agreement in the assessment of protein intake by dietary recall and PNA, due to the existence of proportionality bias. Thus, values can be influenced biased by the magnitude of the measures.

Sarcopenic obesity and its association with frailty and protein-energy wasting in hemodialysis patients: preliminary data from a single center in Japan

BackgroundThis study investigated the prevalence of sarcopenia or sarcopenic obesity and their association with frailty and protein-energy wasting (PEW) in hemodialysis patients.MethodsThe present study enrolled 117 adult hemodialysis patients (35% female, 64 ± 12 years old) from single units of a hemodialysis center. The patients were divided into four groups: normal, obese, sarcopenia, and sarcopenic obesity. Sarcopenia was diagnosed by Asian Working Group for Sarcopenia (AWGS) criteria, and obesity was defined as an extensive percent body fat mass greater than 40% in females and 30% in males. Skeletal muscle mass and percent fat mass were evaluated by multifrequency whole-body bioimpedance electrical analysis after a midweek dialysis session. Handgrip strength and a short physical performance battery (SPPB) were assessed before a dialysis session as indicators of muscle strength and physical performance. Moreover, participants completed the Kihon Checklist and the criteria proposed by the International Society of Renal Nutrition and Metabolism expert panel to classify frailty and PEW. We performed multivariate logistic regression analysis to identify the clinical risk of frailty and PEW in patients with sarcopenia or sarcopenic obesity.ResultsForty-six (39.3%) patients were classified as normal; 18 (15.4%), as obese; 35 (29.9%), as having sarcopenia; and 18 (15.4%), as having sarcopenic obesity. The sarcopenia or sarcopenic obesity group had significantly lower handgrip strength than the normal or obesity group (all p < 0.05). In addition, the sarcopenia and sarcopenic obesity groups had significantly lower SPPB scores than the normal group (p < 0.05, respectively). In the multivariate analysis, the sarcopenic obesity group had a significantly higher risk of frailty than the normal group in the multivariate analysis after adjusting for age and gender (OR 4.518, 95%CI 1.218–16.752, p = 0.024). However, sarcopenic obesity was not associated with a higher likelihood of PEW, and sarcopenia imposed a significantly higher risk of PEW (OR 4.272, 95%CI 1.157–15.778, p = 0.029) than that in the normal group after adjusting for confounding factors.ConclusionSarcopenic obesity was closely associated with frailty compared with the normal condition in HD patients. However, sarcopenic obesity was not associated with a higher likelihood of PEW.

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.

Association of low serum parathyroid hormone with protein-energy wasting in maintenance hemodialysis patients

Objective: To examine the relationship between low serum parathyroid hormone (PTH) and protein-energy wasting (PEW) in patients who underwent maintenance hemodialysis (MHD) treatment. Methods: A cross-sectional study was conducted in MHD patients between June 2015 and August 2017 in 11 MHD centers from Guizhou province. Body composition and physical parameters were measured, clinical data and other related laboratory values were collected according to the medical record system. Participants were assigned to low serum PTH group (PTH<150 ng/L), target PTH group (150 ng/L≤ PTH ≤300 ng/L) and high serum PTH group (PTH>300 ng/L). Multivariate logistic regression analysis was used to analyze the relationship between low serum PTH and risk of PEW, which was diagnosed according to the diagnostic criteria recommened by the International Society of Renal Nutrition and Metabolism (ISRNM). Results: A total of 873 MHD patients (488 males and 385 females) were included in the final analysis, with a mean age of 55.0 (44.0, 67.0) years and a mean hemodialysis duration of 31.0(17.0, 54.0) months. In unadjusted model, low serum PTH group was associated with PEW (OR=2.12, 95% CI: 1.26-3.54, P=0.004), when compared with high serum PTH group. After adjustment for age and sex, low serum PTH group was still significantly associated with PEW (OR=2.09, 95% CI: 1.23-3.52, P=0.006). Further adjustment for diabetes and hypertension, the correlation between low serum PTH group and PEW was still significant (OR=2.02, 95% CI: 1.04-3.90, P=0.037). However, the correlation was not observed in target PTH group and high serum PTH group. Conclusion: Low serum PTH was associated with risk of PEW, regardless of age, sex, history of diabetes and hypertension, and thus it might be a promising indicator of PEW in MHD patients.

Prevalence and Risk of Protein-Energy Wasting Assessed by Subjective Global Assessment in Older Adults With Advanced Chronic Kidney Disease: Results From the EQUAL Study

Prevalence and risk factors for protein-energy wasting (PEW) are poorly studied in the nondialysis, older population with advanced chronic kidney disease (CKD). Our aim was to evaluate the prevalence of PEW in advanced stage CKD patients aged greater than 65years. Furthermore, we aimed to describe risk factors for PEW in the overall study population and among obese individuals. Prospective observational cohort study. The EQUAL study, a European Quality Study on treatment in advanced chronic kidney disease, is a multicenter prospective observational cohort study in six European countries. We included patients aged ≥65 years with incident glomerular filtration rate <20mL/min/1.73m2 not on dialysis attending nephrology care. PEW was assessed by 7-point Subjective Global Assessment (7-p SGA). In general, the study cohort (n=1,334) was overweight (mean body mass index [BMI] 28.4kg/m2). The majority of the patients 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). Muscle wasting and loss of fat tissue were the most frequent alterations according to the SGA subscales, especially in those aged >80years. The prevalence of PEW was higher among women, increased with age, and was higher in those with depression/dementia. PEW was the most common in those with underweight (BMI <22kg/m2), 55% or normal weight (BMI 22-25kg/m2), 40%. In obese individuals (BMI >30kg/m2), 25% were diagnosed with protein wasting. Risk factors for SGA ≤5 in obese people were similar to those for the overall study population. This European multicenter study shows that the prevalence of PEW is high in patients with advanced CKD aged >65years. The risk of PEW increases substantially with age and is commonly characterized by muscle wasting. Our study suggests that focus on nutrition should start early in the follow-up of older adults with CKD.

Comparison of malnutrition inflammation score, anthropometry and biochemical parameters in assessing the difference in protein‐energy wasting between normal weight and obese patients undergoing haemodialysis

Protein-energy wasting (PEW) is prevalent in haemodialysis. Obesity is an independent risk factor of kidney insufficiency, but it is proposed to have beneficial roles in better outcomes in the final stage of disease. Better nutritional status and body reserves are among probable mechanisms, but direct examinations are limited. The present study aimed to investigate whether obese patients have preferable nutritional status compared to normal weight patients based on malnutrition inflammation score (MIS) and other PEW parameters in haemodialysis. This case-control study investigated 52 normal weight (18.5 < body mass index (BMI) < 25 kg/m2 ) and 48 obese (BMI≥30 kg/m2 ) patients on regular haemodialysis. PEW was assessed based on anthropometric and biochemical factors, recent weight changes, appetite, anorexia, dietary intake and MIS. Obese patients had better MIS compared with the normal weight group (P < 0.001), although varying degrees of wasting were prevalent among this group too (75% mild and 25% moderate wasting). The obese group had less significant weight loss (4.2 vs 8%) and anorexia and better appetite. However, a considerable percentage of patients in both groups showed muscle (94.6% of normal weight and 19.5% of obese) and peripheral fat tissue (89.2% of normal weight and 31.7% of obese) losses compared to the 50th percentile. Biochemical parameters were not significantly different between groups except for triglyceride (P = 0.001), transferrin and total iron-binding capacity (P = 0.028). MIS was significantly better in obese patients; however, both groups showed degrees of wasting based on MIS and other PEW parameters. Nutritional status of obese haemodialysis patients should be monitored regularly because of high risk of PEW like other BMI categories.

Comparison of Subjective Global Assessment (SGA) and Protein Energy Wasting (PEW) Score to Nutrition Evaluation Conducted by Registered Dietitian Nutritionists (RDNs) in Identifying Risk of PEW in Maintenance Hemodialysis (MHD) Patients

Comparison of Subjective Global Assessment (SGA) and Protein Energy Wasting (PEW) Score to Nutrition Evaluation Conducted by Registered Dietitian Nutritionists (RDNs) in Identifying Risk of PEW in Maintenance Hemodialysis (MHD) Patients

The role of low protein diet in ameliorating proteinuria and deferring dialysis initiation: what is old and what is new

In the management of patients with chronic kidney diseases (CKD), a low-protein diet usually refers to a diet with protein intake of 0.6 to 0.8 grams per kilogram of body weight per day (g/kg/day) and should include at least 50% high-biologic-value protein. It may be supplemented with essential acids or nitrogen-free ketoanalogues if <0.6 g/kg/d. Low-protein diet can reduce proteinuria especially in non-diabetic CKD patients. In hypoalbuminemic patients it may lead to an increase in serum albumin level. By lowering proteinuria, decreasing nitrogen waste products, ameliorating metabolic burden, mitigating oxidative stress and acidosis, and lowering phosphorus burden, a low-protein diet can help delay dialysis start in advanced CKD. Low-protein diet is safe, since most CKD patients can maintain nitrogen balance by mechanisms of decreasing amino acid oxidation and protein degradation in addition to increased utilization of amino acids for protein synthesis. We suggest a dietary protein intake below 1.0 g/kg/day when estimated glomerular filtration rate (eGFR) falls below 60 mL/min/1.73 m2 or when there is solitary kidney or proteinuria at any level of GFR. Protein intake should be reduced progressively based on severity and progression of CKD and patient's nutritional status with a target of 0.6-0.8 g/kg/d in most patients with eGFR <45 mL/min/1.73 m2. The risk of protein-energy wasting can be overcome by careful attention to quantity and quality of the ingested proteins, sufficient energy intake of 30-35 Kcal/kg/d, and use of dietary supplements. Long-term observations and individualized approaches are needed to further demonstrate the benefits and safety of low-protein diet.

Dénutrition au cours des maladies rénales chroniques : techniques de renutrition et pratique de la nutrition artificielle

Protein energy wasting (PEW) is an independent factor associated with morbi-mortality in chronic kidney disease. Wasting is particularly common in chronic diseases of organs such as kidney disease with a major impact at the stage of dialysis. It covers 20 to 70% of patients diagnosed with chronic kidney disease according to the degree of evolution of the disease and the diagnostic method used patients. Mechanisms of PEW are based mainly on anorexia and metabolic abnormalities caused by kidney disease. Nutritional treatment differs depending on the stage of the kidney disease acute or chronic treated whether or not by dialysis. Nutritional monitoring should be regular, individualized and collaborative to detect a risk of PEW or treat installed PEW. Refeeding techniques should allow all the nutritional needs. Their indications depend on the clinic, biochemical assessment and nutrient intake.