Renal Medicine,IIS-Fundación Jiménez Díaz UAM University Hospital,28040 Madrid,Spain.
Br J Nutr. 2019 Jun;121(11):1271-1278. doi: 10.1017/S0007114519000400. Epub 2019 May 14.
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.
营养不良在透析患者中非常普遍，并与不良预后相关。2008 年，国际肾脏营养与代谢学会（ISRNM）提出了蛋白能量消耗（PEW）的概念，将营养不足和高代谢这两种病理状态归为一种单一的病理情况。2014 年，提出了一种新的简化评分方法，使用血清肌酐按体表面积校正（sCr/BSA）来替代肌肉质量随时间减少的肌肉消耗类别。我们现在比较了 2008 年 PEW-ISRNM 和 2014 年 PEW 评分，以评估 109 名血液透析患者的 PEW 患病率和死亡风险。这是一项回顾性分析，包括横断面数据和中位前瞻性随访 20 个月。根据 2008 年 PEW-ISRNM，PEW 的患病率为 41%，根据 2014 年 PEW 评分，PEW 的患病率为 63%（P <0·002）。采用 2014 年 PEW 评分：29 例（27%）患者为严重营养不良（PEW 评分 2014 0-1），40 例（37%）为中度营养不良（评分 2）。此外，33 例（30%）患者存在轻度消耗，只有 7 例（6%）患者表现为正常营养状态。sCr/BSA 与瘦体总质量呈正相关（R 0·46，P<0·001）。根据 2014 年 PEW 评分诊断为 PEW，但根据 2008 年 PEW-ISRNM 未诊断为 PEW，与短期死亡率显著相关（单因素分析 P=0·0349，但多因素分析 P=0·069）。总之，新的 2014 年 PEW 评分纳入 sCr/BSA 可识别出比 2008 年 PEW-ISRNM 更多的透析患者存在 PEW。虽然 PEW 评分-2014 提供了更及时、更具临床相关性的信息，但需要在更大的研究中证实其与早期死亡率的关系。
