The additional benefit of weighted subjective global assessment (SGA) for the predictability of mortality in incident peritoneal dialysis patients

Yun, Taeyoung; Ko, Ye Eun; Kim, Seung Jung; Kang, Duk Hee; Choi, Kyu Bok; Oh, Hyung Jung; Ryu, Dong Ryeol

doi:10.1097/md.0000000000008421

Cited by 15 publications

(17 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the present study, we found that malnutrition, as assessed by the seven‐point scale SGA, was a significant and independent determinant of increased mortality. Several prospective studies have also reported that malnutrition, as evaluated by the original and modified versions of the SGA, is independently and strongly associated with overall and cardiovascular mortality in the dialysis population ( 12–15 ) . This association might be partially explained by interactions between multiple risk factors related to malnutrition that are also associated with increased mortality, including inadequate dietary intake ( 41–44 ) , presence of cardiovascular disease ( 2 ) , metabolic acidosis ( 45 ) and, most importantly, systemic inflammation ( 46 ) and oxidative stress ( 36 ) .…”

Section: Discussionmentioning

confidence: 99%

“…Oxidative and inflammatory processes act synergistically with respect to promoting protein catabolism, muscle wasting and reduced hepatic albumin synthesis, which together lead to the development of malnutrition in the setting of ESKD ( 10,11 ) . Malnutrition, an independent predictor of mortality in the dialysis population ( 12–15 ) , exacerbates the deleterious effects of systemic inflammation and oxidative stress by increasing the susceptibility to infections and cardiovascular disease risk ( 16,17 ) . It therefore appears reasonable to suggest that a vicious cycle between inflammation, oxidative stress and malnutrition may contribute to the poor survival rates observed in persons on dialysis ( 18 ) .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Skin autofluorescence and malnutrition as predictors of mortality in persons receiving dialysis: a prospective cohort study

Hörner

Selby

2020

J Human Nutrition Diet

View full text Add to dashboard Cite

Background Skin autofluorescence (SAF), which is a measure of accumulation of advanced glycation end‐products (AGE), and malnutrition are each associated with higher mortality in dialysis populations, although no studies have investigated these potentially related associations together. We simultaneously assessed SAF and malnutrition as risk factors for mortality in persons receiving dialysis. Methods SAF was measured in 120 haemodialysis and 31 peritoneal dialysis patients using an AGE Reader (DiagnOptics, Groningen, The Netherlands). Dietary AGE, energy, protein and fat intake, handgrip strength, anthropometry, biochemistry and Subjective Global Assessment were also evaluated. Time to event was days from baseline to death, kidney transplantation or 30 September 2018. Results Median observation time was 576 days, during which 33 (21.9%) patients died. Those who died had higher baseline SAF levels [3.8 ± 1.0 versus 3.3 ± 0.8 arbitrary units (AU); P = 0.001] and were more likely to be malnourished (58% versus 31%; P = 0.006). Malnourished persons who died had higher SAF values than those who died but were well‐nourished (4.2 ± 1.1 versus 3.3 ± 0.7 AU; P = 0.007). Survival was significantly better in participants with baseline SAF below the median and in those well‐nourished than those with baseline SAF above the median and in those malnourished, respectively. Multivariable analysis identified SAF [hazards ratio (HR) = 1.44; 95% confidence interval (CI) = 1.05–1.97; P = 0.02], malnutrition (HR = 2.35; 95% CI = 1.16–4.78; P = 0.02) and chronological age (HR = 1.60; 95% CI = 1.10–2.33; P = 0.01) as independent predictors of mortality. Conclusions Although higher SAF and malnutrition are potentially inter‐related, they were both independently associated with increased mortality in this population. Interventions to improve outcomes by reducing SAF through correction of malnutrition or dietary AGE restriction require testing in prospective studies.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Skin autofluorescence and malnutrition as predictors of mortality in persons receiving dialysis: a prospective cohort study

Hörner

Selby

2020

J Human Nutrition Diet

View full text Add to dashboard Cite

show abstract

“…Serum albumin is commonly considered to be a strong predictor of mortality in dialysis patients [5, 6, 9, 15–17]. Prior studies considered time-varying changes in serum albumin levels in examining the relationship of serum albumin level with mortality in dialysis patients [9, 17].…”

Section: Discussionmentioning

confidence: 99%

Time-varying serum albumin levels and all-cause mortality in prevalent peritoneal dialysis patients: a 5-year observational study

et al. 2019

View full text Add to dashboard Cite

Background In this study, we investigated the association of time-varying serum albumin levels with mortality over a 5-year period in one cohort of patients undergoing long-term peritoneal dialysis (PD) therapy. Methods The participants in this study enrolled 302 patients who underwent long-term PD at a single PD center in Taiwan. We reviewed medical records from 2011 to 2015 retrospectively. Time-averaged albumin level and serum albumin reach rate (defined as the percentage of serum albumin measurements that reached ≥3.5 g/dL) were applied as the predictor variables in the first 2 years (2011–2012). All-cause mortality was used as the outcome variable in the subsequent 3 years (2013–2015). Hazard function of all-cause mortality in the study participants was examined by using Cox proportional hazard regression models . Results Patients with different albumin reach rates (75–< 100%, 50–< 75%, 1–< 50%) did not exhibit a significantly increased risk for all-cause mortality. Patients with a 0% albumin reach rate exhibited a significantly increased risk for all-cause mortality (hazard ratio [HR] 7.59, 95% confidence interval [CI], 2.38–24.21) by fully adjusted analysis. Patients with time-averaged albumin levels of < 3.5 g/dL (HR 15.49, 95% CI 1.74–137.72) exhibited a higher risk for all-cause mortality than those with serum albumin levels ≥4.0 g/dL. Conclusions This study demonstrated that higher serum albumin reach rates and higher time-averaged serum albumin levels are associated with a lower mortality rate over a 5-year period among patients undergoing long-term PD.

show abstract

“…Demographic information and clinical data such as age, gender, smoking status, and comorbidities were collected at the start of HD. Coronary arterial disease (CAD) was defined as a history of angina, myocardial infarction, coronary angioplasty, or coronary artery bypass grafts; cerebrovascular accident (CVA) was defined as a history of transient ischemic attack, stroke, or carotid endarterectomy; and, peripheral arterial disease (PAD) was defined as a history of claudication, any peripheral revascularization procedure, ischemic limb loss, and/or ulceration [19]. Each patient’s medication information was also investigated at baseline.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Aspirin on Preventing Vascular Access Dysfunction in Incident Hemodialysis Patients: A Prospective Cohort Study in Korean Clinical Research Centers for End-Stage Renal Disease (CRC for ESRD)

Kim

et al. 2019

JCM

Self Cite

View full text Add to dashboard Cite

Background: Aspirin is often prescribed empirically to improve the patency of hemodialysis (HD) vascular access. Therefore, this study aimed to investigate the impact of aspirin on the survival of vascular access in incident HD patients with arteriovenous fistula (AVF) or arteriovenous graft (AVG). Methods: A prospective cohort of 881 incident HD patients was enrolled between 2009 and 2014. The primary outcome was defined as the first AVF/AVG intervention or salvage procedure, including percutaneous transluminal angioplasty or surgery for vascular access failure. Cox analyses were performed to determine the association between aspirin usage and the occurrence of the primary outcome. Results: The mean age of the patient group was 57.9 ± 13.4, and 63.8% of the patients were male. Aspirin was prescribed in 241 (27.4%) patients, and the median follow-up duration was 30 months. During follow-up, 180 (20.4%) patients experienced the primary outcome event. Univariate analysis showed that age, gender, presence of diabetes mellitus (DM), preexisting peripheral arterial disease, and the type of vascular access used (AVG versus AVF) were significantly associated with the development of the primary outcome. However, aspirin usage from the baseline was not significantly associated with primary outcome events (hazard ratio (HR): 1.16; 95% confidence interval (CI): 0.84–1.60; p = 0.378). Multivariate analysis showed that gender, the presence of DM, and the type of vascular access were still significantly associated with the occurrence of the primary outcome. Moreover, we did not observe the protective effect of taking aspirin on primary vascular access failure, even in subgroup analyses stratified according to gender, the presence of DM, and the type of vascular access. Conclusion: Physicians should carefully consider when they prescribe aspirin for the prevention of primary vascular access failure in Korean incident HD patients. In addition, larger prospective interventional studies are needed to elucidate the effect of aspirin on vascular access failure.

show abstract

The additional benefit of weighted subjective global assessment (SGA) for the predictability of mortality in incident peritoneal dialysis patients

Abstract: Supplemental Digital Content is available in the text

Cited by 15 publications

References 41 publications

Skin autofluorescence and malnutrition as predictors of mortality in persons receiving dialysis: a prospective cohort study

Skin autofluorescence and malnutrition as predictors of mortality in persons receiving dialysis: a prospective cohort study

Time-varying serum albumin levels and all-cause mortality in prevalent peritoneal dialysis patients: a 5-year observational study

The Effect of Aspirin on Preventing Vascular Access Dysfunction in Incident Hemodialysis Patients: A Prospective Cohort Study in Korean Clinical Research Centers for End-Stage Renal Disease (CRC for ESRD)

Contact Info

Product

Resources

About