Protein energy wasting and long‐term outcomes in nondialysis dependent chronic kidney disease

Franco, Bryan B.; Hopman, Wilma M.; Lamarche, Michelle C; Holden, Rachel M.

doi:10.1111/jorc.12378

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…Patients with CKD and undernutrition had a 2.4 times higher risk of infectious complications, lengthier hospital stay, and increased hospitalisation costs compared to those who were well-nourished [28]. Among adults with CKD, nutritional status assessed through SGNA was associated with kidney failure, mortality, poor physical function and gastrointestinal symptoms [29,30]. In adults on maintenance hemodialysis, individual measures of PEW, such as low BMI, hypoalbuminemia, and normalized protein catabolic rate, have been shown to be associated with infection-related mortality [31].…”

Section: Discussionmentioning

confidence: 99%

Nutritional profile and infection-related hospital admissions in children with chronic kidney disease

Madhileti,

Selvam,

Iyengar

2024

Preprint

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Protein energy wasting (PEW) and undernutrition are highly prevalent in children with chronic kidney disease (CKD), but their impact on clinical outcomes is not well-described. This prospective longitudinal study in children with CKD assessed the association of nutritional parameters with infection-related hospital admissions (IRHA). Methods: Children with CKD2-5D aged 2-18years, infection-free for 1 month were recruited over 5 years. Evaluation for undernutrition by subjective global nutritional assessment and for PEW using pediatric criteria were undertaken and categorised as mild (>2criteria), standard (>3criteria) and modified PEW (>3criteria with short stature). The IRHA (severe viral, bacterial or fungal infections) were recorded. Results: Among 137 children (45 on dialysis; age 123±46 months; 70% males) undernutrition was seen in 60% and PEW in 52%. Over 38±21 months follow-up, 107(78%) required hospital admissions (67% IRHA). The incidence rate of IRHA in days per patient-year was higher in those with undernutrition compared to well-nourished children [1.74(1.27,2.31) vs 0.65(0.44,0.92) p<0.0001] and higher in those with PEW compared to no PEW [1.74(1.30,2.28) vs 0.56(0.36,0.82) p<0.0001] respectively. On adjusted analysis, independent risk factors for IRHA were undernutrition, low BMI, hypoalbuminemia and dialysis status with modified PEW [OR5.34(2.16,13.1) p<0.001] and raised CRP [OR4.66(1.56,13.9) p=0.006] having the highest risk. Additionally, modified PEW and BMI were noted to have a 2-fold risk for recurrent infections. Conclusion: In children with CKD2-5D, incidence rate of IRHA was significantly high in those with undernutrition and PEW. While dialysis, poor nutritional status, inflammation were risk factors for IRHA, modified PEW and BMI were associated with recurrent infections.

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Section: Discussionmentioning

confidence: 99%

Nutritional profile and infection-related hospital admissions in children with chronic kidney disease

Madhileti,

Selvam,

Iyengar

2024

Preprint

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“…In the subgroup analysis, we found that, among patients with a CKD, an NRS 2002score ≥ 3 points was associated with a higher risk for in-hospital mortality. In patients with CKD, protein-energy wasting is common [37] and is associated with disease progression and mortality [38]. A recent study described an association of an NRS 2002-score ≥ 3 with in-hospital mortality also in hospitalized patients with CKD [39].…”

Section: Discussionmentioning

confidence: 99%

Association of Different Malnutrition Parameters and Clinical Outcomes among COVID-19 Patients: An Observational Study

et al. 2022

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Background: Malnutrition is highly prevalent in medical inpatients and may also negatively influence clinical outcomes of patients hospitalized with COVID-19. We analyzed the prognostic implication of different malnutrition parameters with respect to adverse clinical outcomes in patients hospitalized with COVID-19. Methods: In this observational study, consecutively hospitalized adult patients with confirmed COVID-19 at the Cantonal Hospital Aarau (Switzerland) were included between February and December 2020. The association between Nutritional Risk Screening 2002 (NRS 2002) on admission, body mass index, and admission albumin levels with in-hospital mortality and secondary endpoints was studied by using multivariable regression analyses. Results: Our analysis included 305 patients (median age of 66 years, 66.6% male) with a median NRS 2002-score of 2.0 (IQR 1.0, 3.0) points. Overall, 44 patients (14.4%) died during hospitalization. A step-wise increase in mortality risk with a higher nutritional risk was observed. When compared to patients with no risk for malnutrition (NRS 2002 < 3 points), patients with a moderate (NRS 2002 3–4 points) or high risk for malnutrition (NRS 2002 ≥ 5 points) had a two-fold and five-fold increase in risk, respectively (10.5% vs. 22.7% vs. 50.0%, p < 0.001). The increased risk for mortality was also confirmed in a regression analysis adjusted for gender, age, and comorbidities (odds ratio for high risk for malnutrition 4.68, 95% CI 1.18 to 18.64, p = 0.029 compared to patients with no risk for malnutrition). Conclusions: In patients with COVID-19, the risk for malnutrition was a risk factor for in-hospital mortality. Future studies should investigate the role of nutritional treatment in this patient population.

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“…Although factors associated with early mortality have not been fully studied, the majority of early death can be attributed to cardiovascular events or infections, and mortality is significantly higher among PEW patients ( 29 ). PEW may increase susceptibility to catheter-related infections and cardiovascular events related to hemodynamic stress during dialysis ( 30 ). Therefore, targeted nutritional interventions need to be best implemented in the early stage of dialysis.…”

Section: Discussionmentioning

confidence: 99%

An updated clinical prediction model of protein-energy wasting for hemodialysis patients

Chen

Ma²,

Wang³

et al. 2022

Front. Nutr.

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Background and aimProtein-energy wasting (PEW) is critically associated with the reduced quality of life and poor prognosis of hemodialysis patients. However, the diagnosis criteria of PEW are complex, characterized by difficulty in estimating dietary intake and assessing muscle mass loss objectively. We performed a cross-sectional study in hemodialysis patients to propose a novel PEW prediction model.Materials and methodsA total of 380 patients who underwent maintenance hemodialysis were enrolled in this cross-sectional study. The data were analyzed with univariate and multivariable logistic regression to identify influencing factors of PEW. The PEW prediction model was presented as a nomogram by using the results of logistic regression. Furthermore, receiver operating characteristic (ROC) and decision curve analysis (DCA) were used to test the prediction and discrimination ability of the novel model.ResultsBinary logistic regression was used to identify four independent influencing factors, namely, sex (P = 0.03), triglycerides (P = 0.009), vitamin D (P = 0.029), and NT-proBNP (P = 0.029). The nomogram was applied to display the value of each influencing factor contributed to PEW. Then, we built a novel prediction model of PEW (model 3) by combining these four independent variables with part of the International Society of Renal Nutrition and Metabolism (ISRNM) diagnostic criteria including albumin, total cholesterol, and BMI, while the ISRNM diagnostic criteria served as model 1 and model 2. ROC analysis of model 3 showed that the area under the curve was 0.851 (95%CI: 0.799–0.904), and there was no significant difference between model 3 and model 1 or model 2 (all P > 0.05). DCA revealed that the novel prediction model resulted in clinical net benefit as well as the other two models.ConclusionIn this research, we proposed a novel PEW prediction model, which could effectively identify PEW in hemodialysis patients and was more convenient and objective than traditional diagnostic criteria.

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Protein energy wasting and long‐term outcomes in nondialysis dependent chronic kidney disease

Cited by 6 publications

References 25 publications

Nutritional profile and infection-related hospital admissions in children with chronic kidney disease

Nutritional profile and infection-related hospital admissions in children with chronic kidney disease

Association of Different Malnutrition Parameters and Clinical Outcomes among COVID-19 Patients: An Observational Study

An updated clinical prediction model of protein-energy wasting for hemodialysis patients

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