Department of Nephrology, Pingxiang People's Hospital, Pingxiang, China.
Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China.
Ren Fail. 2024 Dec;46(1):2337290. doi: 10.1080/0886022X.2024.2337290. Epub 2024 Apr 4.
The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population. We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model. According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 - 3.54, < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62-0.68, < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, < 0.001). The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.
我们的研究目的是评估全球营养不良倡议（GLIM）标准在评估腹膜透析（PD）人群中营养不良的有效性。我们进行了一项回顾性分析，涉及来自多个机构的 1057 名 PD 患者，这些患者的年龄为 56.1±14.4 岁，464 名（43.9%）为女性，中位随访时间为 45（25，68）个月。根据 GLIM 标准诊断营养不良。终点事件是总死亡率。在所有患者和各种亚组中分析了营养不良和营养良好患者的生存率和死亡风险比（HR）。使用接受者操作特征曲线和综合判别改善（IDI）来区分营养工具预测模型的疗效。根据 GLIM 标准，研究人群中营养不良的患病率为 34.9%。与营养良好的患者相比，整体死亡率的调整 HR 为 2.91（2.39-3.54，<0.001）。在敏感性分析中，除了心血管疾病亚组外，HR 仍然稳健。GLIM 预测 5 年死亡率的曲线下面积为 0.65（0.62-0.68，<0.001）。作为预测长期死亡率的复杂模型，调整因素与 GLIM 相结合的性能比调整因素与 MIS（IDI>0，<0.001）相结合的性能差，但比调整因素与 GNRI（IDI<0，<0.001）相结合的性能好。GLIM 标准为 PD 患者的营养评估提供了一种可行的工具，根据 GLIM 定义的营养不良可以预测预后，具有可接受的性能。
