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A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients.
J Ren Nutr. 2015 Sep; 25(5):412-9.JR

Abstract

OBJECTIVE

Protein-energy wasting (PEW) describes a state of decreased protein and energy fuels and is highly prevalent in hemodialysis patients. As PEW is associated with mortality, it should be detected accurately and easily. This study investigated which nutrition-related test predicts mortality and morbidity best in hemodialysis patients.

DESIGN AND SUBJECTS

Data were used from CONTRAST, a cohort of end-stage kidney disease patients. Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS), Geriatric Nutritional Risk Index (GNRI), composite score of Protein-Energy Nutritional Status (cPENS), serum albumin, serum creatinine, body mass index, and normalized protein nitrogen appearance rate were assessed at baseline. End points were all-cause mortality, cardiovascular events, and infection. Discriminative value of every test was assessed with Harrell's C statistic and calibration tested using the Hosmer-Lemeshow goodness-of-fit test. Ultimately, in every test, 4 groups were created to compare (1) hazard ratios (HR; worst vs best group), (2) HR increase per group, and (3) HR of worst group versus other groups.

RESULTS

In total, 489 patients were analyzed. Median follow-up was 2.97 years (interquartile range, 1.67-4.47 years). MIS, GNRI, albumin, and creatinine discriminated all-cause mortality equally. SGA, cPENS, body mass index, and normalized protein nitrogen appearance were inferior. cPENS and creatinine were inadequately calibrated. Of the remaining tests, GNRI predicted mortality less when comparing HRs. MIS and albumin predicted mortality equally well. In a subanalysis, these also predicted infection equally well, but MIS predicted cardiovascular events better.

CONCLUSION

Of the 8 investigated nutrition-related tests, MIS and albumin predict mortality best in hemodialysis patients. As one has no added value over the other, we conclude that mortality is most easily predicted in hemodialysis patients by serum albumin.

Authors+Show Affiliations

Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands. Electronic address: c.deroijvanzuijdewijn@vumc.nl.Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands.Department of Nephrology, Hôpital de Sacre-Coeur de Montréal, Montréal, Canada.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands.Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25820178

Citation

de Roij van Zuijdewijn, Camiel L M., et al. "A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 25, no. 5, 2015, pp. 412-9.
de Roij van Zuijdewijn CL, ter Wee PM, Chapdelaine I, et al. A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients. J Ren Nutr. 2015;25(5):412-9.
de Roij van Zuijdewijn, C. L., ter Wee, P. M., Chapdelaine, I., Bots, M. L., Blankestijn, P. J., van den Dorpel, M. A., Nubé, M. J., & Grooteman, M. P. (2015). A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 25(5), 412-9. https://doi.org/10.1053/j.jrn.2015.02.005
de Roij van Zuijdewijn CL, et al. A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients. J Ren Nutr. 2015;25(5):412-9. PubMed PMID: 25820178.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients. AU - de Roij van Zuijdewijn,Camiel L M, AU - ter Wee,Piet M, AU - Chapdelaine,Isabelle, AU - Bots,Michiel L, AU - Blankestijn,Peter J, AU - van den Dorpel,Marinus A, AU - Nubé,Menso J, AU - Grooteman,Muriel P C, Y1 - 2015/03/26/ PY - 2014/12/15/received PY - 2015/01/29/revised PY - 2015/02/11/accepted PY - 2015/3/31/entrez PY - 2015/3/31/pubmed PY - 2016/5/31/medline SP - 412 EP - 9 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 25 IS - 5 N2 - OBJECTIVE: Protein-energy wasting (PEW) describes a state of decreased protein and energy fuels and is highly prevalent in hemodialysis patients. As PEW is associated with mortality, it should be detected accurately and easily. This study investigated which nutrition-related test predicts mortality and morbidity best in hemodialysis patients. DESIGN AND SUBJECTS: Data were used from CONTRAST, a cohort of end-stage kidney disease patients. Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS), Geriatric Nutritional Risk Index (GNRI), composite score of Protein-Energy Nutritional Status (cPENS), serum albumin, serum creatinine, body mass index, and normalized protein nitrogen appearance rate were assessed at baseline. End points were all-cause mortality, cardiovascular events, and infection. Discriminative value of every test was assessed with Harrell's C statistic and calibration tested using the Hosmer-Lemeshow goodness-of-fit test. Ultimately, in every test, 4 groups were created to compare (1) hazard ratios (HR; worst vs best group), (2) HR increase per group, and (3) HR of worst group versus other groups. RESULTS: In total, 489 patients were analyzed. Median follow-up was 2.97 years (interquartile range, 1.67-4.47 years). MIS, GNRI, albumin, and creatinine discriminated all-cause mortality equally. SGA, cPENS, body mass index, and normalized protein nitrogen appearance were inferior. cPENS and creatinine were inadequately calibrated. Of the remaining tests, GNRI predicted mortality less when comparing HRs. MIS and albumin predicted mortality equally well. In a subanalysis, these also predicted infection equally well, but MIS predicted cardiovascular events better. CONCLUSION: Of the 8 investigated nutrition-related tests, MIS and albumin predict mortality best in hemodialysis patients. As one has no added value over the other, we conclude that mortality is most easily predicted in hemodialysis patients by serum albumin. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/25820178/A_Comparison_of_8_Nutrition_Related_Tests_to_Predict_Mortality_in_Hemodialysis_Patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(15)00064-3 DB - PRIME DP - Unbound Medicine ER -