Association between modified simple protein-energy wasting (PEW) score and all-cause mortality in patients receiving maintenance hemodialysis

Abstract

Background: Protein-energy wasting (PEW) is a frequently observed complication that leads to increased mortality in hemodialysis patients. However, a multifaceted assessment of PEW by combined objective nutritional parameters has not yet been established. Methods: In total, 144 Japanese patients receiving maintenance hemodialysis at a hemodialysis center were retrospectively followed for 7 years. The primary outcome was all-cause death. The main exposure was a modified simple PEW score (0, 1, 2, 3, or 4), calculated from four parameters: serum albumin and creatinine levels, normalized protein catabolic rate, and body mass index. These parameters are included in the subcategories of PEW as defined by the International Society of Renal Nutrition and Management. The cutoff values of the modified simple PEW score components were based on the receiver operating characteristics curves determined by univariate logistic regression analyses. Risk estimates for all-cause mortality were calculated by the Cox proportional hazards model adjusted for potential confounding factors. Results: During the median 5.7-years follow-up period, 37 patients died of any cause. When patients were divided into three subgroups (G1-G3) based on the modified simple PEW score, a multivariable-adjusted analysis showed that the risks of all-cause death in groups G2 and G3 were significantly higher than in the lowest score group (G1), with hazard risk (95% confidence interval) 3.10 (1.16-8.26) (P = 0.024) and 5.68 (1.85-17.45) (P = 0.002), respectively. Conclusions: The modified simple PEW score is a useful composite indicator of nutritional status that stratifies the risk of all-cause mortality in patients undergoing maintenance hemodialysis.

Emerging cross-talks between chronic kidney disease–mineral and bone disorder (CKD–MBD) and malnutrition–inflammation complex syndrome (MICS) in patients receiving dialysis

“…The panel of the International Society of Renal Nutrition and Metabolism proposed four components of PEW for multifaceted assessment of nutritional status: (i) biochemical indicators such as albumin or pre-albumin; (ii) low body weight, reduced fat, or weight loss; (iii) decreased muscle mass; and (iv) low protein or energy intake [57]. We and others have shown that a low PEW score, which includes one of the definitions for each component, is associated with an elevated risk of all-cause mortality and can be used as an assessment tool [62,63]. Another useful tool for assessment of nutritional status is the nutritional risk index for Japanese hemodialysis patients (NRI-JH), created using a large database of Japanese hemodialysis patients [64].…”

Simplified geriatric nutritional risk index for assessing nutritional status and stratifying mortality risk in patients receiving maintenance hemodialysis

“…Accumulating evidence has shown that GNRI is a good surrogate marker of nutritional status, and that GNRI is a predictor of comorbidities and mortality in patients receiving hemodialysis or peritoneal dialysis [9–13]. A recent meta‐analysis pooled data for 10 739 patients from 19 cohort studies published between 2010 and 2018 [17].…”

“…The four knots of the spline curves were the 5th, 35th, 65th, and 95th percentiles. To compare the predictability performance for all-cause mortality between the original GNRI and the sGNRI-10, we calculated the area under the receiver operating characteristic curve (AUROC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) [13,16]. AUROCs of the original GNRI and the sGNRI-10 were compared by DeLong's test.…”

“…This was a retrospective, observational study involving 218 outpatients with end-stage kidney disease who were receiving maintenance hemodialysis therapy at two hemodialysis facilities beginning on December 1, 2011 [13]. Patients were followed until death, transfer to another hospital, or lost to follow-up.…”

Severe hyperparathyroidism is associated with nutritional impairment in maintenance hemodialysis patients

“…The cut-off values are as follow: nPCR 0.8 g/kg/day, serum albumin 38 g/L, serum Cr/BSA 380 μmol/L/m 2 ( 14 , 15 ). Due to small body size of the study population, the cut-off value of < 18 kg/m 2 for the BMI was selected based on its association with increased mortality in Japanese hemodialysis patients ( 16 , 17 ). BSA was calculated using DuBois & DuBois equation: 0.20247 × height (m) 0 .…”