Are Nutritional Composed Scoring Systems and Protein-Energy Wasting Score Associated With Mortality in Maintenance Hemodialysis Patients?

Vogt, Barbara; Júnior, João Garcia Caramori

doi:10.1053/j.jrn.2015.11.003

Cited by 19 publications

(9 citation statements)

References 33 publications

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“…In patients with ESRD, increased PEW is associated with poor prognosis. A nutritional composed scoring system or dietary inflammatory index shows a correlation between PEW and prognosis in patients with ESRD [ 15 , 16 ]. The pathophysiological mechanisms of PEW have been suggested to be complex including derangements in muscle, adipose tissue, and the gastrointestinal, hematopoietic, and immune systems, complications related to deficiencies of multiple micronutrients, and the maladaptive activation of the inflammatory cascade [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine

et al. 2018

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BackgroundThe association of a higher body mass index (BMI) with better survival is a well-known “obesity paradox” in patients on hemodialysis (HD). However, men and women have different body compositions, which could impact the effect of BMI on mortality. We investigated the effect of gender on the obesity-mortality relationship in Korean patients on HD.MethodsThis study included 2,833 maintenance patients on HD from a multicenter prospective cohort study in Korea (NCT00931970). The relationship between categorized BMI and gender-specific mortality was evaluated by an adjusted Cox proportional hazard model with restricted cubic spline analyses and the Competing risk analysis. We also investigated the effect of changes in BMI over 12 months and serum creatinine level on survival in male and female patients on HD.ResultsThe mean BMI was 22.6 ± 3.3 kg/m2 and the mean follow up duration was 24.2 ± 3.4 months. The patients with the highest quintile of BMI (≥25.1 kg/m2) showed lower mortality (subdistributional hazard ratio [SHR] = 0.63, 95% confidence interval [CI] = 0.43–0.93, P = 0.019) compared with those with the reference BMI quintile. When analyzed by gender, male patients with a BMI over 25.1 kg/m2 had lower mortality risk (HR = 0.43, 95% CI = 0.25–0.75, P = 0.003); however, no significant difference was found in female patients. Increased BMI after 12 months and high serum creatinine were associated with better survival only in male patients on HD.ConclusionsBMI could be used as a risk factor for mortality in male patients on HD. However, the mortality of female patients on HD was not related with baseline and follow-up BMI. This suggests that BMI is a good surrogate marker of lean body composition, especially in male patients on HD.

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Section: Discussionmentioning

confidence: 99%

Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine

et al. 2018

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“…The diagnosis of PEW is important to predict outcomes [8]. The practice guidelines and criteria for evaluating the nutritional status in ESRD patients recommend the coordinated use of biochemical measures, body mass, muscle mass, dietary intake, and an integrative nutritional scoring [9,10].…”

Section: Introductionmentioning

confidence: 99%

Nutritional Status Predicts 10-Year Mortality in Patients with End-Stage Renal Disease on Hemodialysis

2017

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Protein-energy wasting (PEW) is associated with mortality in patients with end-stage renal disease (ESRD) on maintenance hemodialysis. The correct diagnosis of PEW is extremely important in order to predict clinical outcomes. However, it is unclear which parameters should be used to diagnose PEW. Therefore, this retrospective observational study investigated the relationship between mortality and nutritional parameters in ESRD patients on maintenance hemodialysis. A total of 144 patients were enrolled. Nutritional parameters, including body mass index, serum albumin, dietary intake, normalized protein catabolic rate (nPCR), and malnutrition inflammation score (MIS), were measured at baseline. Fifty-three patients died during the study. Survivors had significantly higher nPCR (1.10 ± 0.24 g/kg/day vs. 1.01 ± 0.21 g/kg/day; p = 0.048), energy intake (26.7 ± 5.8 kcal/kg vs. 24.3 ± 4.2 kcal/kg; p = 0.009) and protein intake (0.91 ± 0.21 g/kg vs. 0.82 ± 0.24 g/kg; p = 0.020), and lower MIS (5.2 ± 2.3 vs. 6.1 ± 2.1, p = 0.039). In multivariable analysis, energy intake <25 kcal/kg (HR 1.860, 95% CI 1.018–3.399; p = 0.044) and MIS > 5 (HR 2.146, 95% CI 1.173–3.928; p = 0.013) were independent variables associated with all-cause mortality. These results suggest that higher MIS and lower energy intake are harmful to ESRD patients on maintenance hemodialysis. Optimal energy intake could reduce mortality in these patients.

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“…Results from the CANUSA study revealed that, in CAPD patients, a 1 unit reduction in the SGA score corresponds to a 25% increase in mortality (Canada-USA (CANUSA) Peritoneal Dialysis Study Group, 1996). A recent research also supported the CANUSA study (Vogt & Caramori, 2016). To assess the nutritional state of adult dialysis patients, the NKF kidney disease/dialysis outcomes and quality initiative (K/DOQI) recommends the use of SGA (Ikizler et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Dialysis Failure and its Impact on Holistic Kidney Care: A Case Report

Yip

2021

SAGE Open Nursing

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Introduction Peritonitis remains the primary cause of treatment failure among patients with end-stage kidney disease on continuous ambulatory peritoneal dialysis. However, detailed case analyses illustrating the application of current research in clinical practice remain scant. This case report aimed to elucidate the roles of dialysis nurses in a hospital setting in the management of a 62-year-old male patient with a history of kidney failure secondary to amyloidosis. Case Presentation The patient was diagnosed with continuous ambulatory peritoneal dialysis-associated peritonitis. Management and Outcomes Dialysis nurses applied evidence-based practices in the management of the patient’s exit-site infection, imbalanced nutrition, and psychosocial concerns. The patient was discharged after 7 days, with a comprehensive treatment regimen, including an individualized peritoneal dialysis protocol adjusted to his daily schedules, education on self-care techniques, and continual nutritional management to prevent recurrence and improve his overall health. This case report shows that admissions for continuous ambulatory peritoneal dialysis-associated peritonitis require evidence-based nursing interventions specific to, and geared toward, each patient’s prioritized health problems. Discussion Peritonitis cases are preventable with appropriate nursing interventions that can lower the chance of treatment failure and long-term impact caused by an abrupt switch to hemodialysis. To successfully manage patients with continuous ambulatory peritoneal dialysis-associated peritonitis, dialysis nurses should appreciate the intricacies of the analyses underpinning their professional practices in promoting the patient’s self-care techniques.

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Are Nutritional Composed Scoring Systems and Protein-Energy Wasting Score Associated With Mortality in Maintenance Hemodialysis Patients?

Abstract: Of the 3 investigated scoring systems, SGA and MIS predict mortality in a period of 15.5 ± 5.4 months of follow-up.

Cited by 19 publications

References 33 publications

Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine

Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine

Nutritional Status Predicts 10-Year Mortality in Patients with End-Stage Renal Disease on Hemodialysis

Peritoneal Dialysis Failure and its Impact on Holistic Kidney Care: A Case Report

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