Protein-Energy Wasting Assessment and Clinical Outcomes in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

Khor, Ban-Hock; Tiong, Hui-Ci; Tan, Shing Cheng; Rahman, Raha Abdul; Gafor, Abdul Halim Abdul

doi:10.3390/nu12092809

Cited by 14 publications

(13 citation statements)

References 63 publications

(127 reference statements)

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“…A meta-analysis showed that protein-energy wasting (PEW) assessed using subjective global assessment (SGA) was associated with greater mortality risk (RR: 1.99, 95% CI: 1.36–2.91). Individual nutrition parameters, such as serum chemistry, body mass, muscle mass, and dietary intake, were not consistently associated with mortality in patients with AKI [ 30 ]. Our study showed that the mNUTRIC score was an effective tool to evaluate the prognosis of AKI patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of malnutrition risk in elderly patients with acute kidney injury in the intensive care unit

Wang

et al. 2022

BMC Nephrol

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Background Malnutrition is common in critically ill patients, but nutrition status in critically ill patients with acute kidney injury (AKI) has been poorly studied. Our study aimed to investigate the relationship between malnutrition risk and the occurrence and prognosis of AKI in elderly patients in the intensive care unit (ICU). Methods Data were extracted from the Beijing Acute Kidney Injury Trial (BAKIT). A total of 1873 elderly patients were included and compared according to the clinical characteristics of AKI and non-AKI groups, and those of survivors and non-survivors of AKI in this study. Receiver operating characteristic (ROC) curves were used to analyse the predictive value of the modified Nutrition Risk in Critically Ill (mNUTRIC) score for the occurrence and 28-day prognosis of AKI. Multivariate Cox regression analysis was used to evaluate the effect of the mNUTRIC score on the 28-day mortality in AKI patients. Results Compared with the non-AKI group, AKI patients had higher mNUTRIC scores, and non-survivors had higher mNUTRIC scores than survivors in AKI population. Moreover, multivariate Cox regression showed that 28-day mortality in AKI patients increased by 9.8% (95% CI, 1.018-1.184) for every point increase in the mNUTRIC score, and the mNUTRIC score had good predictive ability for the occurrence of AKI and 28-day mortality in AKI patients. The mortality of AKI patients with mNUTRIC > 4 was significantly increased. Conclusions The elderly patients are at high risk of malnutrition, which affects the occurrence and prognosis of AKI. Adequate attention should be given to the nutritional status of elderly patients. Trial registration This study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875) on 14 December 2011.

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Section: Discussionmentioning

confidence: 99%

Prognostic significance of malnutrition risk in elderly patients with acute kidney injury in the intensive care unit

Wang

et al. 2022

BMC Nephrol

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“…Protein-energy wasting (PEW), a state of decreased body protein mass and energy fuel, is frequently observed in chronic kidney disease (CKD) patients [ 1 ]. The PEW, a CKD-specific nutritional disorder, affects various clinical outcomes [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of the Controlling Nutritional Status (CONUT) Score in Patients at Dialysis Initiation

et al. 2022

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Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD), and affects their prognosis. The Controlling Nutritional Status (CONUT) score is a nutritional screening tool calculated using only blood test data. This study aimed to investigate the prognostic value of CONUT score in patients just initiating dialysis. A total of 311 CKD patients who stably initiated dialysis were enrolled. Only 27 (8.7%) patients were classified as having normal nutritional status. The CONUT score was also independently correlated with elevated C-reactive protein levels (β = 0.485, p < 0.0001). During the median follow-up of 37 months, 100 patients (32.2%) died. The CONUT score was an independent predictor of all-cause mortality (adjusted hazard ratio 1.13, 95% confidence interval 1.04–1.22, p < 0.0024). As model discrimination, the addition of the CONUT score to a prediction model based on established risk factors significantly improved net reclassification improvement (0.285, p = 0.028) and integrated discrimination improvement (0.025, p = 0.023). The CONUT score might be a simplified surrogate marker of the PEW with clinical utility and could predict all-cause mortality, in addition to improving the predictability in CKD patients just initiating dialysis. The CONUT score also could predict infectious-disease mortality.

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“…Screening tools such as subjective global assessment (SGA), nutritional risk screening 2002 (NRS 2002), short nutritional assessment questionnaire, malnutritional screening tool, mini nutritional assessment, and malnutritional universal screening tool are widely used in patients with chronic kidney disease (CKD) where the association with worse outcomes is well‐established 12 . However, in AKI, SGA and NRS 2002 are the only validated tools 13,14 …”

Section: Introductionmentioning

confidence: 99%

“…During inflammation, the rate of albumin production is reduced while the rate of degradation is increased 19 . There is inconsistent evidence for the association of albumin and mortality in AKI patients 13 …”

Section: Introductionmentioning

confidence: 99%

Nutritional assessment and support during continuous renal replacement therapy

Ostermann

Lumlertgul

Mehta

2021

Seminars in Dialysis

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Malnutrition is common in patients with acute kidney injury (AKI). The reasons are multifactorial and include increased protein breakdown, insulin resistance, altered hormonal regulation and pre-existing malnourishment. 1 In patients receiving renal replacement therapy (RRT), nutritional status may also be affected by the inadvertent removal of amino acids, carnitine, trace elements, glucose, and water-soluble vitamins. [2][3][4][5] In addition to these losses, continuous renal replacement therapy (CRRT) can be an important source of unrecognized exogenous calories, too. 6 This review provides an overview of methods for nutritional assessment, the composition of modern CRRT solutions, potential nutrient losses and energy gains, and principles of nutritional adjustment during CRRT. | Malnutrition in AKI and CRRT patientsProtein energy wasting (PEW) refers to the negative metabolic consequences of the acute loss of kidney function on nutritional status. 7 , 8 The pathogenesis is multifactorial and includes inflammation, increased energy expenditure (EE), hypercatabolic state, and nutrient losses during RRT. 9,10 Without adequate nutrition, protein catabolism worsens, resulting in lowered immune function, insulin resistance, and increased mortality. 9 | Nutritional assessment in AKI and CRRT patientsNutritional status can be assessed by various different methods but no single tool has adequate sensitivity or specificity. 111.2.1 | Nutritional scores Screening tools such as subjective global assessment (SGA), nutritional risk screening 2002 (NRS 2002), short nutritional assessment questionnaire, malnutritional screening tool, mini nutritional assessment, and malnutritional universal screening tool are widely used in patients with chronic kidney disease

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Protein-Energy Wasting Assessment and Clinical Outcomes in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

Cited by 14 publications

References 63 publications

Prognostic significance of malnutrition risk in elderly patients with acute kidney injury in the intensive care unit

Prognostic significance of malnutrition risk in elderly patients with acute kidney injury in the intensive care unit

Prognostic Value of the Controlling Nutritional Status (CONUT) Score in Patients at Dialysis Initiation

Nutritional assessment and support during continuous renal replacement therapy

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