Protein energy wasting and long-term outcomes in nondialysis dependent chronic kidney disease.

IF 1.5 4区 医学 Q3 NURSING
Journal of renal care Pub Date : 2022-03-01 Epub Date: 2021-05-30 DOI:10.1111/jorc.12378
Bryan B Franco, Wilma M Hopman, Michelle C Lamarche, Rachel M Holden
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引用次数: 3

Abstract

Background: Nutritional status and protein energy wasting (PEW) is prevalent in patients with nondialysis-dependent chronic kidney disease (CKD). The relationship between PEW and long-term development of clinically important outcomes remains to be examined.

Objectives: To investigate the relationships between PEW, as measured by Subjective Global Assessment (SGA 1-7), and progression to important clinical outcomes: mortality and/or kidney failure.

Design: Prospective cohort design.

Participants: One hundred and thirty-nine participants were well-nourished and 37 moderately malnourished patients with CKD 3-5.

Measurements: The outcomes were 2, 5, and 10-year progression to kidney failure (dialysis or transplant) or mortality, kidney failure alone, and mortality alone. SGA was determined by a registered renal dietitian. Food frequency questionnaires were used to assess dietary intake. Clinical and laboratory baseline characteristics were collected. Multivariable regression models and Cox models were created to examine the relationship between SGA and outcomes.

Results: PEW was associated with the combined outcome of kidney failure or mortality at 2 (p = 0.003), 5 (p = 0.004), but not at 10 (p = 0.73) years. This relationship was primarily driven by the relationship between PEW and kidney failure. In Cox models, the relationship between PEW and kidney failure remained after adjusting for Kidney Failure Risk Equation scores. The multivariable modeling revealed that PEW remained a statistically significant predictor of the combined outcome and ESKD after adjustment for age, estimated glomerular filtration rate (eGFR), sex, albumin-to-creatinine ratio, diabetes, albumin, and protein intake.

Conclusions: PEW, determined by the SGA 1-7, is an important prognostic tool. Further research looking at clinically important outcomes are needed to implement nutritional interventions for nondialysis-dependent CKD patients.

非透析依赖性慢性肾脏疾病的蛋白质能量浪费和长期预后
背景:营养状况和蛋白质能量浪费(PEW)在非透析依赖型慢性肾病(CKD)患者中很普遍。PEW与临床重要结果的长期发展之间的关系仍有待检验。目的:研究主观总体评估(SGA 1-7)测量的PEW与重要临床结果(死亡率和/或肾衰竭)进展之间的关系。设计:前瞻性队列设计。参与者:139名参与者营养良好,37名中度营养不良的CKD 3-5患者。测量:结果为2年、5年和10年进展为肾衰竭(透析或移植)或死亡率、单独肾衰竭和单独死亡率。SGA由注册肾脏营养师测定。使用食物频率问卷来评估饮食摄入量。收集临床和实验室基线特征。建立多变量回归模型和Cox模型来检验SGA与结局之间的关系。结果:PEW与2年(p = 0.003)、5年(p = 0.004)、10年(p = 0.73)时肾衰竭或死亡率的综合结局相关。这种关系主要是由PEW和肾衰竭之间的关系驱动的。在Cox模型中,在调整肾衰竭风险方程评分后,PEW与肾衰竭之间的关系仍然存在。多变量模型显示,在调整年龄、肾小球滤过率(eGFR)、性别、白蛋白与肌酐比值、糖尿病、白蛋白和蛋白质摄入量后,PEW仍然是综合结果和ESKD的统计显著预测因子。结论:由SGA 1-7确定的PEW是一个重要的预后工具。对非透析依赖的CKD患者实施营养干预,需要进一步研究临床重要结果。
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来源期刊
Journal of renal care
Journal of renal care Nursing-Advanced and Specialized Nursing
CiteScore
3.50
自引率
5.30%
发文量
36
期刊介绍: The Journal of Renal Care (JORC), formally EDTNA/ERCA Journal, is the official publication of the European Dialysis and Transplant Nursing Association/European Renal Care Association (EDTNA/ERCA). The Journal of Renal Care is an international peer-reviewed journal for the multi-professional health care team caring for people with kidney disease and those who research this specialised area of health care. Kidney disease is a chronic illness with four basic treatments: haemodialysis, peritoneal dialysis conservative management and transplantation, which includes emptive transplantation, living donor & cadavaric transplantation. The continuous world-wide increase of people with chronic kidney disease (CKD) means that research and shared knowledge into the causes and treatment is vital to delay the progression of CKD and to improve treatments and the care given. The Journal of Renal Care is an important journal for all health-care professionals working in this and associated conditions, such as diabetes and cardio-vascular disease amongst others. It covers the trajectory of the disease from the first diagnosis to palliative care and includes acute renal injury. The Journal of Renal Care accepts that kidney disease affects not only the patients but also their families and significant others and provides a forum for both the psycho-social and physiological aspects of the disease.
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