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Diagnostic Usefulness of the Protein Energy Wasting Score in Prevalent Hemodialysis Patients.
J Ren Nutr. 2018 11; 28(6):428-434.JR

Abstract

OBJECTIVE

To study whether the score proposed by the International Society of Renal Nutrition and Metabolism to define the protein energy wasting (PEW) syndrome has diagnostic validity in patients undergoing dialysis.

DESIGN AND METHODS

Cross-sectional study including 468 prevalent hemodialysis patients from Canary Islands, Spain. Individual PEW syndrome criteria and the number of PEW syndrome categories were related to other objective markers of PEW using linear and logistic regression analyses: subjective global assessment, handgrip strength, bioimpedance-assessed body composition, and levels of high-sensitivity C-reactive protein.

RESULTS

Study participants (34% women) had a median age of 66 years, 37 months of maintenance dialysis, and 50% were diabetics. About 23% of patients had PEW (≥3 PEW categories), and 68% were at risk of PEW (1-2 PEW categories). Low prealbumin was the most frequently found derangement (52% of cases), followed by low albumin (46%), and low protein intake (35%). Across higher number of PEW syndrome categories, patients showed a longer dialysis vintage and had lower creatinine, triglycerides, and transferrin (P for trend <.001 for all). All nutritional assessments not included in the PEW definition worsened across higher number of PEW categories. In multivariable regression analyses, there was a linear inverse relationship between muscle and fat mass as well as handgrip strength with the number of PEW syndrome categories. Likewise, the proportion of subjective global assessment-defined malnutrition and serum concentration of C-reactive protein gradually increased despite adjustment for confounders (P for trend <.05 for all).

CONCLUSION

The PEW score reflects systemic inflammation, malnutrition and wasting among dialysis patients and may thus be used for diagnostic purposes.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Antón-Pérez G
Avericum Hemodialysis Centers, Islas Canarias, Spain. Electronic address: gloria.anton@avericum.com.
Santana-Del-Pino Á
Las Palmas de Gran Canaria University, Las Palmas, Spain.
Henríquez-Palop F
Avericum Hemodialysis Centers, Islas Canarias, Spain.
Monzón T
Avericum Hemodialysis Centers, Islas Canarias, Spain.
Sánchez AY
Avericum Hemodialysis Centers, Islas Canarias, Spain.
Valga F
Avericum Hemodialysis Centers, Islas Canarias, Spain.
Morales-Umpierrez A
Nephrology Department, Molina Orosa Hospital, Arrecife, Lanzarote, Spain.
García-Cantón C
Nephrology Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain.
Rodríguez-Pérez JC
Nephrology Department, Dr. Negrín Hospital, Las Palmas de Gran Canaria, Spain.
Carrero JJ
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

MeSH

AgedC-Reactive ProteinCross-Sectional StudiesElectric ImpedanceFemaleHand StrengthHumansMaleMiddle AgedPrevalenceProtein-Energy MalnutritionRenal DialysisRenal Insufficiency, ChronicSpain

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29983232

Citation

Antón-Pérez, Gloria, et al. "Diagnostic Usefulness of the Protein Energy Wasting Score in Prevalent Hemodialysis Patients." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 28, no. 6, 2018, pp. 428-434.
Antón-Pérez G, Santana-Del-Pino Á, Henríquez-Palop F, et al. Diagnostic Usefulness of the Protein Energy Wasting Score in Prevalent Hemodialysis Patients. J Ren Nutr. 2018;28(6):428-434.
Antón-Pérez, G., Santana-Del-Pino, Á., Henríquez-Palop, F., Monzón, T., Sánchez, A. Y., Valga, F., Morales-Umpierrez, A., García-Cantón, C., Rodríguez-Pérez, J. C., & Carrero, J. J. (2018). Diagnostic Usefulness of the Protein Energy Wasting Score in Prevalent Hemodialysis Patients. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 28(6), 428-434. https://doi.org/10.1053/j.jrn.2018.05.002
Antón-Pérez G, et al. Diagnostic Usefulness of the Protein Energy Wasting Score in Prevalent Hemodialysis Patients. J Ren Nutr. 2018;28(6):428-434. PubMed PMID: 29983232.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic Usefulness of the Protein Energy Wasting Score in Prevalent Hemodialysis Patients. AU - Antón-Pérez,Gloria, AU - Santana-Del-Pino,Ángelo, AU - Henríquez-Palop,Fernando, AU - Monzón,Tania, AU - Sánchez,Ana Y, AU - Valga,Francisco, AU - Morales-Umpierrez,Adelaida, AU - García-Cantón,Cesar, AU - Rodríguez-Pérez,Jose C, AU - Carrero,Juan J, Y1 - 2018/07/05/ PY - 2018/02/20/received PY - 2018/04/19/revised PY - 2018/05/29/accepted PY - 2018/7/10/pubmed PY - 2019/11/14/medline PY - 2018/7/10/entrez SP - 428 EP - 434 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 28 IS - 6 N2 - OBJECTIVE: To study whether the score proposed by the International Society of Renal Nutrition and Metabolism to define the protein energy wasting (PEW) syndrome has diagnostic validity in patients undergoing dialysis. DESIGN AND METHODS: Cross-sectional study including 468 prevalent hemodialysis patients from Canary Islands, Spain. Individual PEW syndrome criteria and the number of PEW syndrome categories were related to other objective markers of PEW using linear and logistic regression analyses: subjective global assessment, handgrip strength, bioimpedance-assessed body composition, and levels of high-sensitivity C-reactive protein. RESULTS: Study participants (34% women) had a median age of 66 years, 37 months of maintenance dialysis, and 50% were diabetics. About 23% of patients had PEW (≥3 PEW categories), and 68% were at risk of PEW (1-2 PEW categories). Low prealbumin was the most frequently found derangement (52% of cases), followed by low albumin (46%), and low protein intake (35%). Across higher number of PEW syndrome categories, patients showed a longer dialysis vintage and had lower creatinine, triglycerides, and transferrin (P for trend <.001 for all). All nutritional assessments not included in the PEW definition worsened across higher number of PEW categories. In multivariable regression analyses, there was a linear inverse relationship between muscle and fat mass as well as handgrip strength with the number of PEW syndrome categories. Likewise, the proportion of subjective global assessment-defined malnutrition and serum concentration of C-reactive protein gradually increased despite adjustment for confounders (P for trend <.05 for all). CONCLUSION: The PEW score reflects systemic inflammation, malnutrition and wasting among dialysis patients and may thus be used for diagnostic purposes. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/29983232/Diagnostic_Usefulness_of_the_Protein_Energy_Wasting_Score_in_Prevalent_Hemodialysis_Patients_ DB - PRIME DP - Unbound Medicine ER -