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Criteria for classification of protein-energy wasting in dialysis patients: impact on prevalence.
Br J Nutr. 2019 06; 121(11):1271-1278.BJ

Abstract

Malnutrition is highly prevalent in dialysis patients and associated with poor outcomes. In 2008, protein-energy wasting (PEW) was coined by the International Society of Renal Nutrition and Metabolism (ISRNM), as a single pathological condition in which undernourishment and hypercatabolism converge. In 2014, a new simplified score was described using serum creatinine adjusted for body surface area (sCr/BSA) to replace a reduction of muscle mass over time in the muscle wasting category. We have now compared PEW-ISRNM 2008 and PEW-score 2014 to evaluate the prevalence of PEW and the risk of death in 109 haemodialysis patients. This was a retrospective analysis of cross sectional data with a median prospective follow-up of 20 months. The prevalence of PEW was 41 % for PEW-ISRNM 2008 and 63 % for PEW-score 2014 (P <0·002). Using PEW-score 2014: twenty-nine patients (27 %) had severe malnutrition (PEW-score 2014 0-1) and forty (37 %) with moderate malnutrition (score 2). Additionally, thirty-three (30 %) patients had mild wasting and only seven patients (6 %) presented a normal nutritional status. sCr/BSA correlated with lean total mass (R 0·46. P<0·001). A diagnosis of PEW according to PEW-score 2014, but not according to PEW-ISRNM 2008, was significantly associated with short-term mortality (P=0·0349) in univariate but not in multivariate analysis (P=0·069). In conclusion, the new PEW-score 2014 incorporating sCr/BSA identifies a higher number of dialysis PEW patients than PEW-ISRNM 2008. Whereas PEW-score-2014 provides timelier and therefore more clinically relevant information, its association with early mortality needs to be confirmed in larger studies.

Authors+Show Affiliations

Renal Medicine,IIS-Fundación Jiménez Díaz UAM University Hospital,28040 Madrid,Spain.Renal Medicine,IIS-Fundación Jiménez Díaz UAM University Hospital,28040 Madrid,Spain.Renal Medicine,IIS-Fundación Jiménez Díaz UAM University Hospital,28040 Madrid,Spain.Renal Medicine,IIS-Fundación Jiménez Díaz UAM University Hospital,28040 Madrid,Spain.

Pub Type(s)

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

Language

eng

PubMed ID

31084673

Citation

Gracia-Iguacel, Carolina, et al. "Criteria for Classification of Protein-energy Wasting in Dialysis Patients: Impact On Prevalence." The British Journal of Nutrition, vol. 121, no. 11, 2019, pp. 1271-1278.
Gracia-Iguacel C, González-Parra E, Mahillo I, et al. Criteria for classification of protein-energy wasting in dialysis patients: impact on prevalence. Br J Nutr. 2019;121(11):1271-1278.
Gracia-Iguacel, C., González-Parra, E., Mahillo, I., & Ortiz, A. (2019). Criteria for classification of protein-energy wasting in dialysis patients: impact on prevalence. The British Journal of Nutrition, 121(11), 1271-1278. https://doi.org/10.1017/S0007114519000400
Gracia-Iguacel C, et al. Criteria for Classification of Protein-energy Wasting in Dialysis Patients: Impact On Prevalence. Br J Nutr. 2019;121(11):1271-1278. PubMed PMID: 31084673.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Criteria for classification of protein-energy wasting in dialysis patients: impact on prevalence. AU - Gracia-Iguacel,Carolina, AU - González-Parra,Emilio, AU - Mahillo,Ignacio, AU - Ortiz,Alberto, Y1 - 2019/05/14/ PY - 2019/5/16/pubmed PY - 2020/5/8/medline PY - 2019/5/16/entrez KW - ISRNM International Society of Renal Nutrition and Metabolism KW - LTM lean tissue mass KW - MUAMC mid-upper arm muscle circumference KW - PEW protein–energy wasting KW - nPCR normalised protein catabolic rate KW - sCr/BSA serum creatinine/body surface area KW - Chronic kidney disease KW - Haemodialysis KW - Malnutrition KW - Mortality KW - Outcomes KW - Protein–energy wasting KW - Sarcopenia SP - 1271 EP - 1278 JF - The British journal of nutrition JO - Br J Nutr VL - 121 IS - 11 N2 - Malnutrition is highly prevalent in dialysis patients and associated with poor outcomes. In 2008, protein-energy wasting (PEW) was coined by the International Society of Renal Nutrition and Metabolism (ISRNM), as a single pathological condition in which undernourishment and hypercatabolism converge. In 2014, a new simplified score was described using serum creatinine adjusted for body surface area (sCr/BSA) to replace a reduction of muscle mass over time in the muscle wasting category. We have now compared PEW-ISRNM 2008 and PEW-score 2014 to evaluate the prevalence of PEW and the risk of death in 109 haemodialysis patients. This was a retrospective analysis of cross sectional data with a median prospective follow-up of 20 months. The prevalence of PEW was 41 % for PEW-ISRNM 2008 and 63 % for PEW-score 2014 (P <0·002). Using PEW-score 2014: twenty-nine patients (27 %) had severe malnutrition (PEW-score 2014 0-1) and forty (37 %) with moderate malnutrition (score 2). Additionally, thirty-three (30 %) patients had mild wasting and only seven patients (6 %) presented a normal nutritional status. sCr/BSA correlated with lean total mass (R 0·46. P<0·001). A diagnosis of PEW according to PEW-score 2014, but not according to PEW-ISRNM 2008, was significantly associated with short-term mortality (P=0·0349) in univariate but not in multivariate analysis (P=0·069). In conclusion, the new PEW-score 2014 incorporating sCr/BSA identifies a higher number of dialysis PEW patients than PEW-ISRNM 2008. Whereas PEW-score-2014 provides timelier and therefore more clinically relevant information, its association with early mortality needs to be confirmed in larger studies. SN - 1475-2662 UR - https://www.unboundmedicine.com/medline/citation/31084673/Criteria_for_classification_of_protein_energy_wasting_in_dialysis_patients:_impact_on_prevalence_ DB - PRIME DP - Unbound Medicine ER -