Dai Li-Li, Li Wei-Li, Zheng Ding-Feng, Wang Wei-Hong, Xie Hao-Fen, Ma Jian-Wei
Department of Nephrology Department, Ningbo First Hospital, Ningbo 315010, China.
Department of Nursing Department, Ningbo First Hospital, Ningbo 315010, China.
Int J Endocrinol. 2022 Aug 25;2022:4419486. doi: 10.1155/2022/4419486. eCollection 2022.
To investigate the nutritional risk, malnutrition, severe malnutrition, and malnutrition prevalence of different stages in chronic kidney disease (CKD) patients with and without diabetes mellitus using the Global Leadership Initiative on Malnutrition (GLIM), and to analyze the causes of malnutrition and to improve the clinical outcomes of patients for early intervention.
A total of 683 patients with CKD who were hospitalized in our hospital from January 2020 to January 2021 were enrolled and divided into subgroups 1 to 5 according to whether they were complicated with diabetes and glomerular filtration rate. Using the second step of the malnutrition (GLIM) diagnostic tool and 2 previously commonly used malnutrition assessment methods (body mass index <18.5 kg/m with poor general condition, 3 points for nutritional deficiency in nutritional risk screening), combined with clinical research on the main causes of malnutrition, the intervention measures were discussed.
The prevalence of malnutrition was 16.7% (114/683) in the patients included in the survey using the diagnostic criteria of malnutrition (GLIM) (excluding whole body muscle mass index). The prevalence of malnutrition in CKD patients with and without diabetes was 23.7% and 12.6%, respectively. The overall prevalence rate of severe malnutrition was 14.2%, and the prevalence rates of those with and without diabetes were 19.0% and 11.4%, respectively; the results of the two methods of malnutrition assessment showed that the prevalence of malnutrition in CKD patients with diabetes was higher than that in the uncombined group. There was no severe malnutrition in patients with CKD stages 1 and 2. From CKD stage 3 onwards, the severe malnutrition in the diabetic group was significantly higher than that in the uncombined group.
With the progression of CKD, the incidence of malnutrition also gradually increased, indicating that malnutrition is related to primary diseases and concomitant diseases. Attention should be paid to the malnutrition of CKD patients with diabetes, and clinical medical staff need to pay early attention to various diseases that lead to the progression of CKD, such as diabetes, primary nephropathy, and other factors, to prevent complications and delay the progression of CKD.
采用全球营养不良领导倡议（GLIM）调查合并和未合并糖尿病的慢性肾脏病（CKD）患者不同阶段的营养风险、营养不良、重度营养不良及各阶段营养不良患病率，分析营养不良原因并进行早期干预以改善患者临床结局。
纳入2020年1月至2021年1月在我院住院的683例CKD患者，根据是否合并糖尿病及肾小球滤过率分为1至5组。采用营养不良（GLIM）诊断工具第二步及2种既往常用的营养不良评估方法（体质指数<18.5 kg/m²且一般状况差、营养风险筛查中营养缺乏得3分），结合营养不良主要原因的临床研究，探讨干预措施。
采用营养不良（GLIM）诊断标准（不包括全身肌肉量指数），纳入调查患者中营养不良患病率为16.7%（114/683）。合并和未合并糖尿病的CKD患者营养不良患病率分别为23.7%和12.6%。重度营养不良总体患病率为14.2%，合并和未合并糖尿病者患病率分别为19.0%和11.4%；两种营养不良评估方法结果显示，合并糖尿病的CKD患者营养不良患病率高于未合并组。CKD 1、2期患者无重度营养不良。从CKD 3期起，糖尿病组重度营养不良显著高于未合并组。
随着CKD进展，营养不良发生率也逐渐升高，提示营养不良与原发病及伴发病有关。应关注合并糖尿病的CKD患者的营养不良情况，临床医务人员需早期关注导致CKD进展的各种疾病，如糖尿病、原发性肾病等因素，预防并发症，延缓CKD进展。
