Kidney Disease Outcomes Quality Initiative (K/DOQI) and the Dialysis Outcomes and Practice Patterns Study (DOPPS): Nutrition guidelines, indicators, and practices
Kidney Disease Outcomes Quality Initiative (K/DOQI) and the Dialysis Outcomes and Practice Patterns Study (DOPPS): Nutrition guidelines, indicators, and practices
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DOI：
10.1053/j.ajkd.2004.08.010
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发表时间：
2004-11-01
影响因子：
13.2
通讯作者：
Pifer, TB
中科院分区：
文献类型：
--
作者：
Combe, C;McCullough, KP;Pifer, TB
背景：营养指标是透析患者发病率和死亡率的重要预测指标。《慢性肾衰竭营养临床实践指南》提供了利用透析结果和实践模式研究（DOPPS）数据评估营养状况的指南。方法：对参与DOPPS的7个国家（法国、德国、意大利、西班牙、日本、英国和美国）患者和医疗机构的代表性样本进行各种营养指标（血清白蛋白、修正主观综合评价、血清肌酐、标准化蛋白质分解代谢率[nPCR]和体重指数）水平的描述。结果：死亡率与血清白蛋白呈强烈的负相关，血清白蛋白浓度低于3.5 g/dL （35 g/L）的患者死亡风险高1.38倍。根据修改后的主观总体评估评分，不同国家的中度和重度营养不良患者比例存在显著差异。在美国的样本中，严重和中度营养不良患者的死亡风险高于非营养不良患者，分别高出33%和5%。血清肌酐浓度与死亡率呈负相关，在欧洲和美国，最低四分位数组的死亡率风险比最高四分位数组高60%至70%。欧洲国家之间的nPCR水平差异很大，在美国的数据中，死亡率和nPCR之间没有关联。在调整了人口统计学和合并症因素后，美国和欧洲样本的死亡风险随着体重指数的增加而降低。结论：DOPPS数据强调了在临床实践中使用多参数对营养状况进行常规评估的重要性，以改善患者的护理。
Background: Nutritional markers are important predictors of morbidity and mortality in dialysis patients. The Clinical Practice Guidelines for Nutrition in Chronic Renal Failure provides guidelines for assessing nutritional status that were evaluated using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Methods: The level of various nutritional markers (serum albumin, modified subjective global assessment, serum creatinine, normalized protein catabolic rate [nPCR], and body mass index) were described for representative samples of patients and facilities from 7 countries (France, Germany, Italy, Spain, Japan, United Kingdom, and United States) participating in the DOPPS. Results: A strong inverse association was observed between mortality and serum albumin, with a mortality risk 1.38 times higher for patients with serum albumin concentration less than 3.5 g/dL (35 g/L). There were significant differences by country in the proportion of moderately and severely malnourished patients as determined by the modified subjective global assessment score. In the US sample, severely and moderately malnourished patients had a higher mortality risk compared with those not malnourished, 33% and 5% higher, respectively. An inverse relationship exists between serum creatinine concentration and mortality, with a mortality risk 60% to 70% higher in the lowest quartile group compared with the highest quartile group in Europe and the United States. Levels of nPCR varied significantly between European countries, and there was no association between mortality and nPCR in US data. After adjustment for demographic and comorbidity factors, the mortality risk decreased as body mass index increased in both US and European samples. Conclusion: DOPPS data highlight the importance of routine assessment of nutritional status, using multiple parameters, in clinical practice to improve patient care.