Comparison of Subjective Global Assessment and Protein Energy Wasting Score to Nutrition Evaluations Conducted by Registered Dietitian Nutritionists in Identifying Protein Energy Wasting Risk in Maintenance Hemodialysis Patients

Abstract

Objective The study compared the 7-point Subjective Global Assessment (SGA) and the Protein Energy Wasting (PEW) Score with Nutrition Evaluations (NutrE) conducted by registered dietitian nutritionists (RDNs) in identifying PEW risk in stage five chronic kidney disease (CKD) patients on maintenance hemodialysis (MHD). Design and Methods This study is a secondary analysis of a cross-sectional study entitled “Development and Validation of a Predictive energy Equation in Hemodialysis”. PEW risk identified by the 7-point SGA and the PEW Score were compared against the NutrE conducted by RDNs through data examination from the original study (reference standard). Subjects A total of 133 patients were included for the analysis. Main Outcome Measures The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) of both scoring tools were calculated when compared against the reference standard. Results The patients were predominately African American (n=112, 84.2%), non-Hispanic (n=101, 75.9%), and male (n=80, 60.2%). Both the 7-point SGA (sensitivity =78.6%, specificity = 59.1%, PPV = 33.9%, NPV = 91.2%, PLR = 1.9 and NLR = 0.4) and the PEW Score (sensitivity = 100%, specificity= 28.6%, PPV = 27.2%, NPV = 100%, PLR = 1.4 and NLR = 0) were more sensitive than specific in identifying PEW risk. The 7-point SGA may miss 21.4% patients having PEW and falsely identify 40.9% of patients who do not have PEW. The PEW Score can identify PEW risk in all patients but 71.4% of patients identified may not have PEW risk. Conclusions Both the 7-point SGA and the PEW Score could identify PEW risk. The 7-point SGA was more specific and the PEW Score was more sensitive. Both scoring tools were found to be clinically confident in identifying patients who were actually not at PEW risk.

Feasibility and effectiveness of pre‐emptive rehabilitation in persons approaching dialysis (PREHAB)

“…Nutritional status was maintained during the intervention and on starting dialysis, which is encouraging considering that CKD and dialysis are commonly associated with reduced nutritional status, protein energy wasting (PEW), muscle wasting and sarcopenia, (Fouque et al 2011;Carrerro et al 2013;Cupisti et al 2013). Both HGS and SGA are considered valid and reliable markers of functional and nutritional status, and predict morbidity and mortality in CKD (Steiber et al 2007;Chang et al 2011;Cuppari et al 2014;Dai et al 2017;Sum et al 2017), and these were maintained in our study. Previous studies comparing different nutritional interventions, particularly in pre-dialysis CKD, are scarce, however Campbell et al (2008) found that a 12-week nutritional intervention programme improved nutritional status and HRQoL, possibly due to increased frequency of patient follow-up and more regular adjustments in nutritional treatment.…”

“…; Sum et al . ), and these were maintained in our study. Previous studies comparing different nutritional interventions, particularly in pre‐dialysis CKD, are scarce, however Campbell et al .…”

The additional benefit of weighted subjective global assessment (SGA) for the predictability of mortality in incident peritoneal dialysis patients

“…However, there are various causes of PEW in patients with kidney disease, and SGA is a recommended tool for nutritional assessment but not a tool to identify PEW since SGA alone does not provide any insight into the different causes of PEW. [ 4 , 40 ] This disassociation might be found between younger and older patient groups.…”

Prescribing Hemodialysis or Hemodiafiltration: When One Size Does Not Fit All the Proposal of a Personalized Approach Based on Comorbidity and Nutritional Status

“…The following elements were considered and integrated: Nutritional markers and integrated scores (albumin, pre-albumin, cholesterol; body size, Body mass index (BMI), Malnutrition Inflammation Score (MIS), Subjective Global Assessment (SGA)) [ 43 , 44 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]; Life expectancy: age, comorbidity (Charlson Index), and dialysis vintage [ 60 , 63 ]; Kinetic goals (Kt/V; n-PCR; calcium phosphate and PTH control; beta-2 microglobulin levels) [ 16 , 19 , 20 , 21 , 22 ]; Technical aspects: vascular access (fistula versus catheter, degree of functionality, problems found) [ 64 , 65 ]; Residual kidney function, weight gain [ 66 , 67 , 68 ]; Dialysis tolerance (intradialysis hypotension, post-dialysis fatigue and subjective evaluation of the effect of dialysis on quality of life) [ 69 ]. …”