Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Nephrol Dial Transplant. 2010 Aug;25(8):2662-71. doi: 10.1093/ndt/gfq031. Epub 2010 Feb 26.
Evaluation of nutritional risk, one of the strongest predictors of morbidity and mortality in maintenance haemodialysis (HD) patients, is a difficult process especially in patients with compounding conditions that prevent subjective assessment by subjective global assessment or malnutrition-inflammation score (MIS).
In this study, we developed and characterized a score for the assessment of nutritional status in dialysis patients based solely on objectively measurable criteria. Our prospective observational cohort included 81 prevalent HD patients (53 men and 28 women) with a mean age of 64.3 +/- 11.9 years. The study period encompassed 26.9 +/- 14.3 months. The quantitative and comprehensive scoring system, named Objective Score of Nutrition on Dialysis (OSND), was calculated by combining anthropometric measurements (the change in end-dialysis dry weight in the past 3-6 months, body mass index, skinfold thickness and mid-arm circumference) with three laboratory tests: albumin, transferrin and cholesterol levels. The sum of all seven components of OSND results in a score from 5 (severely malnourished) to 32 (normal). We compared our OSND system with the accepted MIS and phase angle (PA) measurements derived by bioelectric impedance analysis.
The OSND correlated significantly with hospitalization days (r = -0.334; P = 0.002) and frequency of hospitalization (r = -0.373; P = 0.001), as well as with lean body mass and fat mass, MIS, PA and interleukin-6 levels. The Cox proportional hazard-calculated relative risk for death for each five-unit decrease in the OSND was 2.2 (95% CI, 1.3 to 3.8; P = 0.003) comparable with the predictions provided by MIS [for each five-unit increase in MIS, hazard ratio (HR) was 1.8 with 95% CI, 1.2 to 2.8; P = 0.007] and PA (for each 1-unit decrease in PA, HR was 2.9 with 95% CI, 1.5 to 5.6; P = 0.001).
The OSND thus provides a comprehensive scoring system with significant associations with prospective hospitalization and mortality in chronic HD patients as well as measures of nutrition and inflammation.
评估营养风险是维持性血液透析（HD）患者发病率和死亡率的最强预测因素之一，对于合并多种病症的患者来说，这是一个困难的过程，因为这些病症会妨碍主观整体评估或营养不良-炎症评分（MIS）的主观评估。
在这项研究中，我们开发并描述了一种仅基于客观可测量标准评估透析患者营养状况的评分方法。我们的前瞻性观察队列包括 81 例现患 HD 患者（53 名男性和 28 名女性），平均年龄为 64.3±11.9 岁。研究期间为 26.9±14.3 个月。定量和全面的评分系统，命名为透析时的营养客观评分（OSND），是通过将人体测量学测量值（过去 3-6 个月的终末期干体重变化、体重指数、皮褶厚度和上臂中部周长）与三种实验室检查结果（白蛋白、转铁蛋白和胆固醇水平）相结合计算得出的。OSND 的所有七个组成部分的总和得出 5（严重营养不良）至 32（正常）的分数。我们将 OSND 系统与公认的 MIS 和生物电阻抗分析得出的相位角（PA）测量值进行了比较。
OSND 与住院天数（r=-0.334；P=0.002）和住院频率（r=-0.373；P=0.001）显著相关，与瘦体重和体脂、MIS、PA 和白细胞介素-6 水平相关。OSND 每降低 5 个单位，Cox 比例风险计算的死亡相对风险为 2.2（95%CI，1.3 至 3.8；P=0.003），与 MIS 提供的预测值相当[MIS 每增加 5 个单位，危险比（HR）为 1.8，95%CI，1.2 至 2.8；P=0.007]和 PA（PA 每降低 1 个单位，HR 为 2.9，95%CI，1.5 至 5.6；P=0.001）。
因此，OSND 提供了一种全面的评分系统，与慢性 HD 患者的前瞻性住院和死亡率以及营养和炎症的测量值具有显著相关性。
