Xi Wei-Zhen, Wu Chen, Liang Ya-Li, Wang Ling-Ling, Cao Yu-Han
Kidney Internal Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu Anhui, China.
Front Nutr. 2023 Jan 6;9:1002498. doi: 10.3389/fnut.2022.1002498. eCollection 2022.
Malnutrition is a common complication of Chronic Kidney Disease (CKD), and it is the risk factor of CKD prognosis. This study aim to evaluate the nutritional status of inpatients with CKD by using the Subjective Global Assessment (SGA), and to analyze the related factors of malnutrition; and to provide effective reference for early detection of malnutrition status in patients with CKD and timely nutrition intervention.
A total of 426 patients (238 male patients, 188 female patients) aged 62.62 ± 14.61 and 61.14 ± 14.82, respectively admitted to the Nephrology Department of Wannan Medical College from February 2020 to December 2020 were selected and included in to this study by convenience sampling. 426 patients with CKD were evaluated by SGA. Human body weight, hemoglobin (Hb), total protein (TP), albumin (ALB), pre-albumin (PA), qualitative analysis of urinary protein and other laboratory indexes were collected and measured. The correlation between malnutrition and age, education, gender, diet, CKD stage and other factors was analyzed by spearman correlation analysis.
The incidence of malnutrition was 85.7% among 426 patients with CKD. Gender, age, education level, CKD stage, diabetes mellitus, weight loss and reduced food intake were related to SGA nutritional assessment ( < 0.05). The expression levels of ALB, PA and Hb in the malnutrition group were significantly lower than those in the normal group ( < 0.05). The degree of malnutrition in CKD patients was significant negatively correlated with the expression levels of ALB ( = -0.188), PA = -0.262) and Hb ( = -0.176) ( < 0.05). The multivariate Logistic regression analysis model showed that female (OR = 2.155), ≥60 years old (OR = 7.671), weight loss (OR = 10.691), reduced food intake (OR = 28.953), moderate and severe serum ALB expression (OR = 3.391 and 8.326) were risk factors for malnutrition in patients with CKD ( < 0.05). Malnutrition was correlated with the results of qualitative examination of urinary protein ( = 0.268, < 0.05).
Gender, age, weight loss, reduced food intake, serum ALB expression were independently associated with malnutrition in patients with chronic kidney disease, Hence, the medical staff should take timely and effective nutrition intervention for the patients with malnutrition, delay the renal function damage of patients with CKD and improve the quality of life of patients. Inpatients with CKD, especially women, should increase their dietary intake, maintain normal weight and improve their nutritional status.
营养不良是慢性肾脏病（CKD）的常见并发症，也是CKD预后的危险因素。本研究旨在采用主观全面评定法（SGA）评估CKD住院患者的营养状况，分析营养不良的相关因素；为早期发现CKD患者的营养不良状况及及时进行营养干预提供有效参考。
采用方便抽样法，选取2020年2月至2020年12月在皖南医学院附属弋矶山医院肾内科住院的426例患者（男性238例，女性188例），年龄分别为62.62±14.61岁和61.14±14.82岁，纳入本研究。采用SGA对426例CKD患者进行评估。收集并测定患者的体质量、血红蛋白（Hb）、总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）、尿蛋白定性分析等实验室指标。采用Spearman相关性分析营养不良与年龄、文化程度、性别、饮食、CKD分期等因素的相关性。
426例CKD患者中，营养不良发生率为85.7%。性别、年龄、文化程度、CKD分期、糖尿病、体重减轻和进食减少与SGA营养评定相关（P<0.05）。营养不良组ALB、PA和Hb表达水平显著低于正常组（P<0.05）。CKD患者营养不良程度与ALB（r=-0.188）、PA（r=-0.262）和Hb（r=-0.176）表达水平呈显著负相关（P<0.05）。多因素Logistic回归分析模型显示，女性（OR=2.155）、≥60岁（OR=7.671）、体重减轻（OR=10.691）、进食减少（OR=28.953）、血清ALB中度和重度表达（OR=3.391和8.326）是CKD患者营养不良的危险因素（P<0.05）。营养不良与尿蛋白定性检查结果相关（r=0.268，P<0.05）。
性别、年龄、体重减轻、进食减少、血清ALB表达与慢性肾脏病患者营养不良独立相关，因此，医护人员应及时对营养不良患者进行有效营养干预，延缓CKD患者肾功能损害，提高患者生活质量。CKD住院患者，尤其是女性，应增加饮食摄入量，维持正常体重，改善营养状况。
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