Rashid Ishfaq, Tiwari Pramil, D'Cruz Sanjay, Jaswal Shivani
Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Punjab, India.
Department of General Medicine, Government Medical College and Hospital (GMCH), Chandigarh, India.
PLOS Glob Public Health. 2023 Jan 17;3(1):e0001301. doi: 10.1371/journal.pgph.0001301. eCollection 2023.
Despite not being frequently recognized, malnutrition, a consequence of chronic kidney disease, negatively affects morbidity, mortality, functional activity, and patient's quality of life. Management of this condition is made more difficult by the dearth of knowledge regarding the symptom burden brought on by inadequate nutritional status. Additionally, there are multiple tools to evaluate nutritional status in CKD; but, Pt-Global web tool/PG-SGA used in oncology, has not been investigated in chronic kidney disease patients. This study aimed to explore the nutritional status, symptom burden and also investigate the predictive validity of Pt-Global web tool/PG-SGA among pre-dialysis diabetic and non-diabetic chronic kidney disease patients.
This cross-sectional study was carried out at a renal clinic of a tertiary care public teaching hospital. Nutritional status and symptom burden was evaluated by employing a 'Pt-Global web tool/PG-SGA' which is considered as a preeminent interdisciplinary tool in oncology and other chronic catabolic conditions. The predictive validity of the Pt-Global web tool/PG-SGA, referred as overall score for malnutrition was ascertained using Receiver Operating Curves (ROC). The conclusions were drawn using descriptive statistics, correlation, and regression analysis.
In a sample of 450 pre-dialysis CKD patients, the malnutrition was present in 292(64.9%) patients. Diabetic CKD patients exhibit higher proportion of malnutrition 159(35.3%). The prevalence of malnutrition was exacerbated by eGFR reduction. The overall Pt-Global web tool/PGA-SGA score was significantly influenced by the symptoms of fatigue (81.5%), appetite loss (54.8%), physical pain (45.3%), constipation (31.78%), dry mouth (26.2%), and feeling full quickly (25.8%). The ROC analysis showed that the AUC for the total PG-SGA score was 0.988 (95% CI: 0.976-1.000), indicating that it is a reliable indicator of malnutrition. The sensitivity (84.2%) for identifying malnutrition was low when using the conventional tool cut off score of ≥9. Instead, it was discovered that a score of ≥3 had a greater sensitivity (99.3%) and specificity (44.3%) and was therefore recommended.
This study not only presents empirical evidence of poor nutritional status in CKD patients but also reveals that it is worse in patients with diabetes, hypoalbuminemia, and poorer kidney function (well recognized risk factors for cardiovascular disease). Early diagnosis and management of symptoms contributing malnutrition will reduce mortality and CKD progression. The Pt-Global web tool/PG-SGA total score of 3 or more appears to be the ideal cut off score for identifying malnutrition, which can be utilized by dietician for improving malnutrition.
尽管营养不良作为慢性肾脏病的一个后果并不常被重视，但它会对发病率、死亡率、功能活动以及患者生活质量产生负面影响。由于对营养状况不佳所带来的症状负担缺乏了解，使得这种情况的管理变得更加困难。此外，有多种工具可用于评估慢性肾脏病患者的营养状况；但是，肿瘤学中使用的Pt-Global网络工具/患者整体营养状况主观全面评定法（PG-SGA）尚未在慢性肾脏病患者中进行研究。本研究旨在探讨透析前糖尿病和非糖尿病慢性肾脏病患者的营养状况、症状负担，并研究Pt-Global网络工具/PG-SGA的预测效度。
本横断面研究在一家三级护理公立教学医院的肾脏科门诊进行。采用“Pt-Global网络工具/PG-SGA”评估营养状况和症状负担，该工具在肿瘤学和其他慢性分解代谢状况中被视为卓越的跨学科工具。使用受试者工作特征曲线（ROC）确定Pt-Global网络工具/PG-SGA作为营养不良总体评分的预测效度。通过描述性统计、相关性分析和回归分析得出结论。
在450例透析前慢性肾脏病患者样本中，292例（64.9%）存在营养不良。糖尿病慢性肾脏病患者中营养不良的比例更高，为159例（35.3%）。估算肾小球滤过率（eGFR）降低会加剧营养不良的患病率。Pt-Global网络工具/PG-SGA的总体评分受疲劳症状（81.5%）、食欲减退（54.8%）、身体疼痛（45.3%）、便秘（31.78%）、口干（26.2%）和饱腹感快（25.8%）的显著影响。ROC分析显示，PG-SGA总评分的曲线下面积（AUC）为0.988（95%可信区间：0.976 - 1.000），表明它是营养不良的可靠指标。使用传统工具截断值≥9来识别营养不良时，其敏感性（84.2%）较低。相反，发现评分≥3具有更高的敏感性（99.3%）和特异性（44.3%），因此被推荐使用。
本研究不仅提供了慢性肾脏病患者营养状况不佳的实证依据，还揭示出糖尿病、低白蛋白血症和肾功能较差（公认的心血管疾病危险因素）的患者情况更糟。对导致营养不良的症状进行早期诊断和管理将降低死亡率和慢性肾脏病的进展。Pt-Global网络工具/PG-SGA总评分3分或更高似乎是识别营养不良的理想截断值，营养师可利用这一标准来改善营养不良状况。
