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Effects of Protein-Energy Wasting (PEW) and hyperphosphatemia on the prognosis in Japanese maintenance hemodialysis patients: A five-year follow-up observational study.
Clin Nutr ESPEN. 2020 04; 36:134-138.CN

Abstract

BACKGROUND & AIMS

In dialysis patients, malnutrition is a poor prognostic factor. In patients with chronic kidney disease (CKD), malnutrition is qualitatively different from general malnutrition, which is defined as "Protein-Energy Wasting (PEW)." Dietary therapy for the enhancement of PEW requires the aggressive intake of protein. Conversely, as protein intake and phosphorus intake correlate positively, increasing the protein intake increases the phosphorus intake, which is a poor prognostic factor in dialysis patients. One of the treatments for hyperphosphatemia in dialysis patients is the intake restriction of phosphorus by dietary counseling. However, protein uptake to maintain and augment the nutritional status and the protein intake restriction to correct hyperphosphatemia are contradictory treatments. Hence, this study aims to investigate the effects of PEW and hyperphosphatemia on the prognosis in hemodialysis patients.

METHODS

We enrolled 60 outpatients who underwent maintenance hemodialysis for 6 months (May-November 2012) at Iga City General Hospital (Mie, Japan). In November 2012, we assessed the presence or absence of PEW and hyperphosphatemia in patients and evaluated the survival rate over the next 5 years.

RESULTS

Overall, 10 patients (17%) were diagnosed as PEW. While 17 patients (28%) exhibited average phosphorus level >6.0 mg/dL (hyperphosphatemia). The 5-year survival rate was 30% in the PEW group, 66% in the non-PEW group, 57% in the hyperphosphatemia group, and 61% in the non-hyperphosphatemia group. A statistically significant difference existed between the PEW and non-PEW groups (P = 0.021). However, we observed no significant difference between the hyperphosphatemia and non-hyperphosphatemia groups.

CONCLUSIONS

This study suggests that PEW affects the prognosis more than hyperphosphatemia in maintenance hemodialysis patients. The normalization of the serum phosphorus level by the protein intake restriction could prevent secondary hyperparathyroidism and vascular calcification. Conversely, restricting the protein intake poses a risk of malnutrition. In fact, early death occurred in patients with PEW in this study. Perhaps, patients with PEW should prioritize improving their nutritional status rather than controlling the serum phosphorus level.

Authors+Show Affiliations

Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan; Department of Nutrition, Tokushima University Hospital, Japan.Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan.Department of Nutrition, Iga City General Hospital, Japan.Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan.Department of Surgery, Iga City General Hospital, Japan.Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan; Department of Nutrition, Tokushima University Hospital, Japan. Electronic address: hamada@tokushima-u.ac.jp.

Pub Type(s)

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

Language

eng

PubMed ID

32220356

Citation

Inoue, Arisa, et al. "Effects of Protein-Energy Wasting (PEW) and Hyperphosphatemia On the Prognosis in Japanese Maintenance Hemodialysis Patients: a Five-year Follow-up Observational Study." Clinical Nutrition ESPEN, vol. 36, 2020, pp. 134-138.
Inoue A, Ishikawa E, Shirai Y, et al. Effects of Protein-Energy Wasting (PEW) and hyperphosphatemia on the prognosis in Japanese maintenance hemodialysis patients: A five-year follow-up observational study. Clin Nutr ESPEN. 2020;36:134-138.
Inoue, A., Ishikawa, E., Shirai, Y., Murata, T., Miki, C., & Hamada, Y. (2020). Effects of Protein-Energy Wasting (PEW) and hyperphosphatemia on the prognosis in Japanese maintenance hemodialysis patients: A five-year follow-up observational study. Clinical Nutrition ESPEN, 36, 134-138. https://doi.org/10.1016/j.clnesp.2020.01.004
Inoue A, et al. Effects of Protein-Energy Wasting (PEW) and Hyperphosphatemia On the Prognosis in Japanese Maintenance Hemodialysis Patients: a Five-year Follow-up Observational Study. Clin Nutr ESPEN. 2020;36:134-138. PubMed PMID: 32220356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Protein-Energy Wasting (PEW) and hyperphosphatemia on the prognosis in Japanese maintenance hemodialysis patients: A five-year follow-up observational study. AU - Inoue,Arisa, AU - Ishikawa,Eiji, AU - Shirai,Yumiko, AU - Murata,Tomohiro, AU - Miki,Chikao, AU - Hamada,Yasuhiro, Y1 - 2020/02/04/ PY - 2019/06/04/received PY - 2020/01/07/revised PY - 2020/01/13/accepted PY - 2020/3/30/entrez PY - 2020/3/30/pubmed PY - 2021/6/29/medline KW - Hyperphosphatemia KW - Malnutrition KW - Nutritional disorder KW - Protein intake KW - Protein-energy wasting SP - 134 EP - 138 JF - Clinical nutrition ESPEN JO - Clin Nutr ESPEN VL - 36 N2 - BACKGROUND & AIMS: In dialysis patients, malnutrition is a poor prognostic factor. In patients with chronic kidney disease (CKD), malnutrition is qualitatively different from general malnutrition, which is defined as "Protein-Energy Wasting (PEW)." Dietary therapy for the enhancement of PEW requires the aggressive intake of protein. Conversely, as protein intake and phosphorus intake correlate positively, increasing the protein intake increases the phosphorus intake, which is a poor prognostic factor in dialysis patients. One of the treatments for hyperphosphatemia in dialysis patients is the intake restriction of phosphorus by dietary counseling. However, protein uptake to maintain and augment the nutritional status and the protein intake restriction to correct hyperphosphatemia are contradictory treatments. Hence, this study aims to investigate the effects of PEW and hyperphosphatemia on the prognosis in hemodialysis patients. METHODS: We enrolled 60 outpatients who underwent maintenance hemodialysis for 6 months (May-November 2012) at Iga City General Hospital (Mie, Japan). In November 2012, we assessed the presence or absence of PEW and hyperphosphatemia in patients and evaluated the survival rate over the next 5 years. RESULTS: Overall, 10 patients (17%) were diagnosed as PEW. While 17 patients (28%) exhibited average phosphorus level >6.0 mg/dL (hyperphosphatemia). The 5-year survival rate was 30% in the PEW group, 66% in the non-PEW group, 57% in the hyperphosphatemia group, and 61% in the non-hyperphosphatemia group. A statistically significant difference existed between the PEW and non-PEW groups (P = 0.021). However, we observed no significant difference between the hyperphosphatemia and non-hyperphosphatemia groups. CONCLUSIONS: This study suggests that PEW affects the prognosis more than hyperphosphatemia in maintenance hemodialysis patients. The normalization of the serum phosphorus level by the protein intake restriction could prevent secondary hyperparathyroidism and vascular calcification. Conversely, restricting the protein intake poses a risk of malnutrition. In fact, early death occurred in patients with PEW in this study. Perhaps, patients with PEW should prioritize improving their nutritional status rather than controlling the serum phosphorus level. SN - 2405-4577 UR - https://www.unboundmedicine.com/medline/citation/32220356/Effects_of_Protein_Energy_Wasting__PEW__and_hyperphosphatemia_on_the_prognosis_in_Japanese_maintenance_hemodialysis_patients:_A_five_year_follow_up_observational_study_ DB - PRIME DP - Unbound Medicine ER -