Effect of protein-energy wasting on prognosis of maintenance hemodialysis patients
Objective:Abnormal nutritional status is one of the risk factors closely related to poor prognosis in maintenance hemodialysis (MHD) patients. In order to provide a unified description of consumption, malnutrition, and inflammation in chronic kidney disease patients, The International Association of Renal Nutrition and Metabolism (ISRNM) has introduced the concept of "protein-energy wasting" (PEW). The purpose of this study was to evaluate the PEW status of MHD patients in our hemodialysis center and its ability to predict the prognosis of such patients.Methods:A total of 60 MHD patients at the Sichuan Provincial People's Hospital who met the study enrollment criteria were prospectively followed up for 45 months. PEW diagnosis was performed at baseline according to four indicators (serum albumin, body mass index, muscle volume, and dietary intake), and the modified quantitative subjective global assessment (MQSGA) nutritional status scale was used to measure the nutritional status of patients. COX proportional risk model was used to analyze the relationship between PEW and the components of the diagnostic criteria for PEW and the death of patients.Results:The mean age of the 60 MHD patients was (59.65±13.18) years, 26.7% of the patients met the PEW diagnosis, and 14 patients died during a follow-up period of 45 months. COX proportional risk model analysis suggested that PEW was independently associated with death in MHD patients. Among the components of the diagnostic criteria for PEW, only plasma albumin < 38 g/L was independently associated with death in MHD patients. MQSGA score >10 as the evaluation index of malnutrition had no correlation with patient death, but each point increase of MQSGA score had an independent correlation with the death of patients.Conclusion:PEW diagnosis based on the ISRNM criteria can effectively predict the poor prognosis of MHD patients. Among patients diagnosed with PEW, those with serum albumin <38 g/L have a greater risk of death.
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