Comparison between Global Leadership Initiative on Malnutrition criteria and protein-energy wasting in patients with kidney failure undergoing peritoneal dialysis.

Abstract

Background: Protein-energy wasting (PEW) is the chronic kidney disease (CKD)-specific diagnosis encompassing malnutrition. PEW is associated with adverse outcomes, including those receiving peritoneal dialysis (PD). Identifying PEW requires accurate methods to improve diagnosis. The Global Leadership Initiative on Malnutrition (GLIM) criteria is focused on validating a global consensus for malnutrition diagnosis in adults in clinical settings. While the GLIM criteria has been extensively studied in other clinical populations, there is limited evidence about the agreement with PEW in the PD setting. The aim of this study was to assess the agreement, accuracy, sensitivity, and specificity of GLIM criteria in comparison to the malnutrition inflammation score (MIS), a widely used tool to diagnose PEW in patients on dialysis.

Methods: This was a cross-sectional study of patients undergoing PD. PEW was diagnosed using MIS score. Nutritional assessment was performed to identify malnutrition using GLIM criteria. Phenotypic criteria were assessed using low body mass index, low fat-free mass index, or low muscle strength. Etiology criteria were evaluated using high serum C-reactive protein or reduced food intake. The concordance between GLIM and MIS was evaluated by the Kappa test. A ROC-curve was used for identifying area under curve (AUC), sensitivity and specificity of GLIM.

Results: Patients undergoing PD (n=154) were included in the study. Participants had a median age of 40 (29-51) years and 46.7% were male. PEW/malnutrition was diagnosed using MIS score in 35.3% and in 27.3 % using the GLIM criteria. In comparison with MIS (used as the diagnostic reference), the sensitivity of GLIM was 65.8%, specificity 61.6 %, and AUC was 0.63. The weighted Kappa coefficient was (k 0.15, p=0.02.).

Conclusion: GLIM criteria did not perform better than MIS in diagnosing PEW/malnutrition in patients in PD. Future research to assess the association of GLIM criteria with clinical outcomes is needed.