Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Clinical Research Centre, Kingston General Hospital, Kingston, Ontario, Canada.
J Ren Care. 2022 Mar;48(1):14-23. doi: 10.1111/jorc.12378. Epub 2021 May 30.
Nutritional status and protein energy wasting (PEW) is prevalent in patients with nondialysis-dependent chronic kidney disease (CKD). The relationship between PEW and long-term development of clinically important outcomes remains to be examined.
To investigate the relationships between PEW, as measured by Subjective Global Assessment (SGA 1-7), and progression to important clinical outcomes: mortality and/or kidney failure.
Prospective cohort design.
One hundred and thirty-nine participants were well-nourished and 37 moderately malnourished patients with CKD 3-5.
The outcomes were 2, 5, and 10-year progression to kidney failure (dialysis or transplant) or mortality, kidney failure alone, and mortality alone. SGA was determined by a registered renal dietitian. Food frequency questionnaires were used to assess dietary intake. Clinical and laboratory baseline characteristics were collected. Multivariable regression models and Cox models were created to examine the relationship between SGA and outcomes.
PEW was associated with the combined outcome of kidney failure or mortality at 2 (p = 0.003), 5 (p = 0.004), but not at 10 (p = 0.73) years. This relationship was primarily driven by the relationship between PEW and kidney failure. In Cox models, the relationship between PEW and kidney failure remained after adjusting for Kidney Failure Risk Equation scores. The multivariable modeling revealed that PEW remained a statistically significant predictor of the combined outcome and ESKD after adjustment for age, estimated glomerular filtration rate (eGFR), sex, albumin-to-creatinine ratio, diabetes, albumin, and protein intake.
PEW, determined by the SGA 1-7, is an important prognostic tool. Further research looking at clinically important outcomes are needed to implement nutritional interventions for nondialysis-dependent CKD patients.
非透析依赖性慢性肾脏病（CKD）患者普遍存在营养状况和蛋白质能量消耗（PEW）。PEW 与长期重要临床结局的关系仍有待研究。
研究通过主观整体评估（SGA 1-7）测量的 PEW 与重要临床结局（死亡和/或肾衰竭）进展的关系。
前瞻性队列设计。
139 名营养良好的患者和 37 名中重度营养不良的 CKD 3-5 期患者。
结局为 2、5 和 10 年进展为肾衰竭（透析或移植）或死亡、肾衰竭单独、死亡单独。SGA 由注册营养师确定。使用食物频率问卷评估饮食摄入量。收集临床和实验室基线特征。建立多变量回归模型和 Cox 模型，以检查 SGA 与结局之间的关系。
PEW 与 2 年（p=0.003）、5 年（p=0.004）但 10 年（p=0.73）时肾衰竭或死亡的联合结局相关。这种关系主要是由 PEW 与肾衰竭之间的关系驱动的。在 Cox 模型中，在调整肾衰竭风险方程评分后，PEW 与肾衰竭之间的关系仍然存在。多变量建模显示，在调整年龄、估计肾小球滤过率（eGFR）、性别、白蛋白-肌酐比、糖尿病、白蛋白和蛋白质摄入量后，PEW 仍然是联合结局和终末期肾病的统计学显著预测因素。
通过 SGA 1-7 确定的 PEW 是一种重要的预后工具。需要进一步研究有临床意义的结局，以便为非透析依赖性 CKD 患者实施营养干预。
