{"title":"Estimated protein intake and prognosis in hospitalised heart failure: A focus on patients with and without chronic kidney disease.","authors":"Taishi Dotare, Maeda Daichi, Yuya Matsue, Yudai Fujimoto, Tsutomu Sunayama, Takashi Iso, Taisuke Nakade, Shoichiro Yatsu, Sayaki Ishiwata, Yutaka Nakamura, Yuka Akama, Shoko Suda, Takao Kato, Masaru Hiki, Takatoshi Kasai, Tohru Minamino","doi":"10.1016/j.clnesp.2024.11.006","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>In patients with heart failure (HF), differences in the association between estimated protein intake (PI) and prognosis in those with and without chronic kidney disease (CKD) remain to be clarified. This study aimed to investigate whether the prognostic effects of the estimated PI differ between patients with HF with and without CKD.</p><p><strong>Methods: </strong>We included patients who required hospitalisation owing to worsening HF between 2015 and 2019 and assessed the estimated PI based on the adjusted Maroni formula using the body mass index and urinary urea nitrogen level. Patients were stratified into the higher and lower estimated PI groups according to the median value of the estimated PI at the time of admission. The primary outcome was all-cause mortality.</p><p><strong>Results: </strong>Among the 694 enrolled patients, 286 had CKD. A lower estimated PI was independently associated with a worse nutritional status. During a median follow-up period of 17.2 months, 175 all-cause deaths occurred, including 99 and 76 in the lower and higher estimated PI groups, respectively. In the Kaplan-Meier curves, the lower estimated PI group was associated with higher overall mortality. However, lower estimated PI was significantly associated with all-cause mortality in patients without CKD, but not in those with CKD, after adjustment for covariates. A significant interaction in terms of prognostic effect was observed between the presence or absence of CKD and estimated PI.</p><p><strong>Conclusions: </strong>Among patients with HF, prognostic effect of the estimated PI may differ between patients with and without CKD.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical nutrition ESPEN","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.clnesp.2024.11.006","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background and aims: In patients with heart failure (HF), differences in the association between estimated protein intake (PI) and prognosis in those with and without chronic kidney disease (CKD) remain to be clarified. This study aimed to investigate whether the prognostic effects of the estimated PI differ between patients with HF with and without CKD.
Methods: We included patients who required hospitalisation owing to worsening HF between 2015 and 2019 and assessed the estimated PI based on the adjusted Maroni formula using the body mass index and urinary urea nitrogen level. Patients were stratified into the higher and lower estimated PI groups according to the median value of the estimated PI at the time of admission. The primary outcome was all-cause mortality.
Results: Among the 694 enrolled patients, 286 had CKD. A lower estimated PI was independently associated with a worse nutritional status. During a median follow-up period of 17.2 months, 175 all-cause deaths occurred, including 99 and 76 in the lower and higher estimated PI groups, respectively. In the Kaplan-Meier curves, the lower estimated PI group was associated with higher overall mortality. However, lower estimated PI was significantly associated with all-cause mortality in patients without CKD, but not in those with CKD, after adjustment for covariates. A significant interaction in terms of prognostic effect was observed between the presence or absence of CKD and estimated PI.
Conclusions: Among patients with HF, prognostic effect of the estimated PI may differ between patients with and without CKD.
背景和目的：在心力衰竭（HF）患者中，有慢性肾脏病（CKD）和无慢性肾脏病（CKD）患者的估计蛋白质摄入量（PI）与预后之间的差异仍有待明确。本研究旨在探讨估计蛋白质摄入量对患有和未患有慢性肾脏病的高血压患者的预后影响是否存在差异：我们纳入了 2015 年至 2019 年期间因高血压恶化而需要住院治疗的患者，并根据调整后的马罗尼公式，使用体重指数和尿素氮水平评估了估计 PI。根据入院时估计 PI 的中位值，将患者分为估计 PI 较高和较低两组。主要结果是全因死亡率：在 694 名登记患者中，286 人患有慢性肾脏病。估计 PI 值越低，营养状况越差。在中位 17.2 个月的随访期间，共有 175 例全因死亡，其中估计 PI 较低和较高组别分别有 99 例和 76 例死亡。在卡普兰-梅耶曲线中，估计 PI 较低的组别总死亡率较高。然而，在对协变量进行调整后，估计 PI 较低的组与非 CKD 患者的全因死亡率显著相关，但与 CKD 患者的全因死亡率无关。有无慢性肾脏病与估计PI之间在预后效应方面存在明显的交互作用：结论：在高血压患者中，有无慢性肾脏病患者的估计 PI 对预后的影响可能不同。
期刊介绍：
Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.
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