Kirushnan B B, Rao B Subba, Annigeri R, Balasubramanian S, Seshadri R, Prakash K C, Vivek V
Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India.
Indian J Nephrol. 2017 Jul-Aug;27(4):277-283. doi: 10.4103/0971-4065.202830.
Malnutrition, inflammation, and atherosclerosis are significant problems in patients on hemodialysis. A prospective, observational study in 100 hemodialysis patients for 2 years was conducted. The primary outcomes were hospitalizations and mortality at the end of 2 years. The mean age was 61 ± 11.3 years and 69% were male. Seven patients did not complete the study (five underwent transplant and two were shifted to other units). Serum albumin was significantly lower in malnourished patients at 6 months from the beginning of the study period (3.58 vs. 3.79 g/dl, = 0.001). Malnutrition based on subjective global assessment (SGA) was seen in 30 (32%) patients: mild to moderate in 27 (29%) and severe in 3 (3%). Inflammation was seen in 73 (78.5%) patients and intimal-medial thickness of >1.1 mm indicating significant atherosclerosis was seen in 73 (78.5%) patients. Modified SGA score and malnutrition-inflammation score (MIS) were significantly more in the malnourished group. Statistically significant association was seen between hospitalization and mortality in the malnourished population, and the odds ratio of death in malnourished patients was 9.83 (95% confidence interval: 2.8-34.3, < 0.001). There was a moderate correlation between malnutrition assessed by modified SGA and MIS score ( = 0.54, < 0.001). Mortality rate was 37% in patients with mild to moderate and 67% in severe malnutrition. Hospital admission was seen in 43 (46%) patients and was significantly more common in malnourished compared to well-nourished patients (77% vs. 32%, < 0.001). Multiple logistic regression analysis showed that malnutrition by Modified SGA was the only significant variable associated with mortality at 2 years, and addition of MIS score did not improve the predictive ability of the model to modified SGA. We recommend the use of modified SGA and serial serum albumin to monitor nutrition in hemodialysis patients.
营养不良、炎症和动脉粥样硬化是血液透析患者面临的重大问题。我们对100名血液透析患者进行了一项为期2年的前瞻性观察研究。主要结局是2年末的住院率和死亡率。平均年龄为61±11.3岁，男性占69%。7名患者未完成研究（5名接受了移植，2名转至其他单位）。从研究期开始6个月时，营养不良患者的血清白蛋白显著降低（3.58 vs. 3.79 g/dl，P = 0.001）。根据主观全面评定法（SGA），30例（32%）患者存在营养不良：27例（29%）为轻度至中度，3例（3%）为重度。73例（78.5%）患者存在炎症，73例（78.5%）患者的内膜中层厚度>1.1 mm，表明存在明显的动脉粥样硬化。营养不良组的改良SGA评分和营养不良-炎症评分（MIS）显著更高。在营养不良人群中，住院与死亡率之间存在统计学显著关联，营养不良患者的死亡比值比为9.83（95%置信区间：2.8 - 34.3，P < 0.001）。改良SGA评估的营养不良与MIS评分之间存在中度相关性（r = 0.54，P < ；0.001）。轻度至中度营养不良患者的死亡率为37%，重度营养不良患者为67%。43例（46%）患者有住院情况，与营养良好的患者相比，营养不良患者的住院情况明显更常见（77% vs. 32%，P < 0.001）。多因素逻辑回归分析显示，改良SGA评定的营养不良是与2年死亡率相关的唯一显著变量，添加MIS评分并未提高该模型对改良SGA的预测能力。我们建议使用改良SGA和连续血清白蛋白来监测血液透析患者的营养状况。
