Utility of the Global Leadership Initiative on Malnutrition criteria for the nutritional assessment of patients with end‐stage renal disease receiving chronic hemodialysis

Abstract

Background: Malnutrition is associated with adverse outcomes in patients on chronic haemodialysis. Thus, identifying accurate methods for diagnosing malnutrition is essential. The present retrospective study investigated the utility of the new Global Leadership Initiative on Malnutrition (GLIM) criteria in patients undergoing chronic haemodialysis. Methods: Phase angle and fat-free mass index (FFMI) were derived using bioelectrical impedance analysis. Malnutrition was determined when the subjects had at least one phenotypic criterion (weight loss, low body mass index [BMI] or FFMI).Results: This study included 103 patients undergoing chronic haemodialysis and 46 (44.7%) patients were diagnosed as malnourished. Malnutrition determined using the GLIM criteria was associated with increased risks of allcause death (hazard ratio = 3.0, p = 0.044) and infection requiring hospitalisation (hazard ratio = 2.4, p = 0.015), independent of age, sex and comorbidities. However, malnutrition was not related to major adverse cardiovascular events (p = 0.908). We further evaluated the longitudinal changes in phenotypic parameters. Subjects with median levels of highsensitivity C-reactive protein exceeding 5 mg L -1 exhibited decreased body weight and BMI (p = 0.015 and 0.016, respectively). In addition, body weight, BMI and FFMI were reduced in subjects with a median protein catabolic rate of < 1.0 mg kg -1 day -1 , even after adjustment for age, sex and comorbidities (p = 0.026, 0.053 and 0.039, respectively). Conclusions: Malnutrition assessed using the GLIM criteria could be a useful predictor of mortality and infection in patients on chronic haemodialysis. To improve nutritional status, approaches for decreasing inflammation and increasing protein intake are needed.

Validity and feasibility of the global leadership initiative on malnutrition diagnostic concept in older people: a literature review from August 2021 to August 2022

“…No phenotypic GLIM criterion alone was related to mortality, whereas the combined GLIM construct did, that is adjusted hazard ratio 3. Hospitalization requiring infections was related to malnutrition, whereas major adverse cardiovascular events were not [28].…”

Application of Bioelectrical Impedance Analysis in Nutritional Management of Patients with Chronic Kidney Disease

“…The LTI of HD patients was positively correlated with serum albumin [ 50 , 53 ] and serum prealbumin [ 50 ]. The LTI was also positively correlated with protein intake [ 53 , 54 ] and body cell mass (BCM) [ 53 ], but negatively correlated with age [ 53 ]. Another study of 52 HD patients showed that percentage of muscle mass (MM/%) was independently inversely associated with inflammation [ 55 ].…”

Application of bioelectrical impedance analysis in nutritional management of patients with chronic kidney disease

“…The LTI of HD patients was positively correlated with serum albumin [50,53] and serum prealbumin [50]. The LTI was also positively correlated with protein intake [53,54], body cell mass (BCM) [53], but negatively correlated with age [53]. Another study of 52 HD patients showed that percentage of muscle mass (MM/%) was independently inversely associated with inflammation [55].…”