Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China.
School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China.
Nutrients. 2023 Jun 5;15(11):2640. doi: 10.3390/nu15112640.
Malnutrition is a risk factor for disease progression and poor prognosis in chronic kidney disease (CKD). However, the complexity of nutritional status assessment limits its clinical application. This study explored a new method of nutritional assessment in CKD (stage 1-5) patients using the Subjective Global Assessment (SGA) as the gold standard and evaluated its applicability. The kappa test was used to analyze the consistency of the Renal Inpatient Nutrition Screening Tool (Renal iNUT) with SGA and protein-energy wasting. Logistic regression analysis was used to analyze the risk factors of CKD malnutrition and calculate the prediction probability of multiple indicators combined for the diagnosis of CKD malnutrition. The receiver operating characteristic curve of the prediction probability was drawn to evaluate its diagnostic efficiency. A total of 161 CKD patients were included in this study. The prevalence of malnutrition according to SGA was 19.9%. The results showed that Renal iNUT had a moderate consistency with SGA and a general consistency with protein-energy wasting. Age > 60 years (odds ratio, OR = 6.78), neutrophil-lymphocyte ratio > 2.62 (OR = 3.862), transferrin < 200 mg/dL (OR = 4.222), phase angle < 4.5° (OR = 7.478), and body fat percentage < 10% (OR = 19.119) were risk factors for malnutrition in patients with CKD. The area under the receiver operating characteristic curve of multiple indicators for the diagnosis of CKD malnutrition was 0.89 (95% confidence interval: 0.834-0.946, < 0.001). This study demonstrated that Renal iNUT has good specificity as a new tool for the nutrition screening of CKD patients, but its sensitivity needs to be optimized. Advanced age, high neutrophil-lymphocyte ratio, low transferrin level, low phase angle, and low body fat percentage are risk factors for malnutrition in patients with CKD. The combination of the above indicators has high diagnostic efficiency in the diagnosis of CKD malnutrition, which may be an objective, simple, and reliable method to evaluate the nutritional status of patients with CKD.
营养不良是慢性肾脏病（CKD）疾病进展和预后不良的危险因素。然而，营养状况评估的复杂性限制了其临床应用。本研究探讨了一种新的 CKD（1-5 期）患者营养评估方法，以主观全面评估（SGA）为金标准，并评估其适用性。kappa 检验用于分析肾脏住院患者营养筛查工具（Renal iNUT）与 SGA 和蛋白质能量消耗的一致性。Logistic 回归分析用于分析 CKD 营养不良的危险因素，并计算多个指标联合诊断 CKD 营养不良的预测概率。绘制预测概率的受试者工作特征曲线，以评估其诊断效率。共纳入 161 例 CKD 患者。根据 SGA 评估的营养不良患病率为 19.9%。结果表明，Renal iNUT 与 SGA 具有中度一致性，与蛋白质能量消耗具有一般一致性。年龄＞60 岁（比值比，OR=6.78）、中性粒细胞-淋巴细胞比值＞2.62（OR=3.862）、转铁蛋白＜200mg/dL（OR=4.222）、相位角＜4.5°（OR=7.478）和体脂百分比＜10%（OR=19.119）是 CKD 患者营养不良的危险因素。用于诊断 CKD 营养不良的多个指标的受试者工作特征曲线下面积为 0.89（95%置信区间：0.834-0.946，<0.001）。本研究表明，Renal iNUT 作为 CKD 患者营养筛查的新工具具有良好的特异性，但敏感性需要优化。高龄、高中性粒细胞-淋巴细胞比值、低转铁蛋白水平、低相位角和低体脂百分比是 CKD 患者营养不良的危险因素。上述指标的组合在诊断 CKD 营养不良方面具有较高的诊断效率，可能是评估 CKD 患者营养状况的一种客观、简单、可靠的方法。
