Nutrition Assessment and Risk Prediction in Dialysis Patients—A New Integrative Score

Benyamini, Sara Blumberg; Katzir, Zeev; Biro, Alexander; Cernes, Relu; Shalev, Batya; Chaimy, T.; Barnea, Zvi

doi:10.1053/j.jrn.2014.05.001

Cited by 18 publications

(9 citation statements)

References 68 publications

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“…Because of the differing recommendations for energy requirements, it is critical to perform regular nutrition assessment of individual patients, and dietary energy intake prescription may need to be modified accordingly. A valid and reliable nutrition assessment tool should be used to detect early signs of PEW, such as Malnutrition Inflammation Score (MIS), 37 Subjective Global Assessment (SGA) Composite Nutritional Score, 38 Integrative Clinical Nutrition Dialysis Score (ICNDS), 39 or Objective Score of Nutrition on Dialysis (OSND) 40 …”

Section: Recommended Nutrition Goals In Ckdmentioning

confidence: 99%

Chronic Kidney Disease and Nutrition Support

Chan

2021

Nut in Clin Prac

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Individuals with chronic kidney disease (CKD), particularly those undergoing maintenance dialysis, are prone to protein-energy wasting (PEW), the latter of which can be ameliorated with different methods of nutrition support. Dietary counseling guided by dietitians is the key for preventing and managing PEW in CKD. If dietary counseling per se fails to meet the recommended energy and protein requirements, the addition of oral nutrition supplements (ONSs) would be necessary. When these initial measures cannot attain the recommended energy and protein requirements, nutrition support, including enteral tube feeding or parenteral nutrition (PN), should be considered as a viable option to improve nutrition status. Partial PN, comprising intraperitoneal PN (IPPN) and intradialytic PN (IDPN) therapies, may be attempted as supplemental nutrition support in patients with PEW requiring peritoneal dialysis and hemodialysis, respectively. Despite the debatable effectiveness of IPPN for patients undergoing peritoneal dialysis, it remains a feasible means in these patients. The indications for IPPN in patients undergoing peritoneal dialysis include inadequate dietary intake of energy and protein, and barriers of oral intake and other forms of enteral supplementation such as issues with suitability, tolerance, and compliance. Nonetheless, in the case of spontaneous dietary consumption of energy and protein meeting the difference between the IDPN provision and the nutrition targets, the use of IDPN is rational. In patients with PEW and malfunctioning gastrointestinal tract, as well as those whose enteral intake (with or without partial PN) is below the recommended nutrient requirements, total PN becomes a relevant nutrition intervention.

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Section: Recommended Nutrition Goals In Ckdmentioning

confidence: 99%

Chronic Kidney Disease and Nutrition Support

Chan

2021

Nut in Clin Prac

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“…The incidence of CKD is rising and is likely to continue to do so for the foreseeable future, driven mainly by the rise in type 2 diabetes and an ageing population [ 1 , 2 ]. The highest incidence of end-stage renal disease (ESRD) now affects adults between the ages of 70 and 85 years at a rate three times higher than adults between the ages of 50 and 60 years, so that almost 25% of the dialysis population is at least 80 years old [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Frailty and comorbidity are independent predictors of outcome in patients referred for pre-dialysis education

et al. 2016

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BackgroundThe incidence of chronic kidney disease (CKD) is rising and is likely to continue to do so for the foreseeable future, with the fastest growth seen among adults ≥75 years of age. Elderly patients with advanced CKD are likely to have a higher burden of comorbidity and frailty, both of which may influence their disease outcome. For these patients, treatment decisions can be complex, with the current lack of robust prognostic tools hindering the shared decision-making process. The current study aims to assess the impact of comorbidity and frailty on the outcomes of patients referred for pre-dialysis education.MethodsWe performed a single-centre study of patients (n = 283) referred for pre-dialysis education between 2010 and 2012. The Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS) were used to assess comorbid disease burden and frailty, respectively. Follow-up data were collected until February 2015.ResultsThe CCI and CFS scores at the time of referral to the pre-dialysis service were independent predictors of mortality. Within the study follow-up period, 76% of patients with a high CFS score at the time of pre-dialysis education had died, with 63% of these patients not commencing dialysis before death.ConclusionA relatively simple frailty scale and comorbidity score could be used to predict survival and better inform the shared decision-making process for patients with advanced kidney disease.

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“…Protein‐energy wasting (PEW) along with inflammation is common in patients with end‐stage kidney disease on haemodialysis (HD). The powerful association of PEW with morbidity, mortality and with an increased hospitalization rate in these patients is well described in literature . Therefore, an early detection of PEW and an intervention to ameliorate it can lead to better outcomes in HD patients.…”

mentioning

confidence: 99%

Evaluating haemodialysis patient's nutritional status: Body mass index or body cell mass index?

Valente¹,

Caetano²,

Oliveira³

et al. 2019

Nephrology

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Objective Evaluate which of two combinations of parameters based on International Society of Renal Nutrition and Metabolism recommendations could better identify patients with protein‐energy wasting (PEW) and to compare the relationship of these two combinations with other clinical and body composition parameters. Methods This was a multicentre longitudinal study with 24 months of follow‐up. The PEW patients were characterized by: Group A (GA) – normalized protein catabolic rate (nPCR) < 1.0 g/kg per day, albumin <3.8 g/dL and body cell mass index (BCMI) < 6.4 kg/m2 (n = 203); Group B (GB) – nPCR <1.0 g/kg per day, albumin <3.8 g/dL and body mass index (BMI) <23 kg/m2 (n = 109). All the patients who did not meet these requirements were considered “well‐nourished” (GA: n = 1818; GB: n = 3292). Results When compared to the well‐nourished patients, PEW patients in the GA presented higher age, Kt/V, C‐reactive protein, relative overhydration, fat tissue index (FTI); lower creatinine, albumin, nPCR, PTH, haemoglobin, phosphorus, calcium X phosphorus product, potassium, dry weight, BMI, BCMI, lean tissue index, %IDWG . In the GB, well‐nourished patients FTI was significantly higher. In Cox analysis, the combination with BCMI was a strong independent predictor of mortality in these patients (hazard ratio: 1.48; confidence interval: 1.00–2.19; P = 0.048), even after adjustment. Although GB combination seemed to be also a predictor of death (hazard ratio: 2.67; confidence interval: 1.92–3.71; P < 0.001), when adjusted, the association remained no longer significant. Conclusion A new combination of parameters including protein intake, albumin and BCMI demonstrated significant associations with other nutrition and inflammation parameters as well as with mortality.

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Nutrition Assessment and Risk Prediction in Dialysis Patients—A New Integrative Score

Cited by 18 publications

References 68 publications

Chronic Kidney Disease and Nutrition Support

Chronic Kidney Disease and Nutrition Support

Frailty and comorbidity are independent predictors of outcome in patients referred for pre-dialysis education

Evaluating haemodialysis patient's nutritional status: Body mass index or body cell mass index?

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