Nutritional Status Predicts 10-Year Mortality in Patients with End-Stage Renal Disease on Hemodialysis.
Nutritional Status Predicts 10-Year Mortality in Patients with End-Stage Renal Disease on Hemodialysis.
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DOI：
10.3390/nu9040399
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发表时间：
2017-04-18
期刊：
影响因子：
5.9
通讯作者：
Park Y
中科院分区：
文献类型：
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作者：
Kang SS;Chang JW;Park Y
蛋白质-能量消耗（PEW）与终末期肾病（ESRD）维持性血液透析患者的死亡率相关。PEW的正确诊断对于预测临床结果非常重要。然而，目前尚不清楚哪些参数应用于诊断PEW。因此，本回顾性观察性研究调查了接受维持性血液透析的ESRD患者的死亡率与营养参数之间的关系。共入组144例患者。在基线时测量营养参数，包括体重指数、血清白蛋白、膳食摄入量、标准化蛋白质分解代谢率（nPCR）和营养不良炎症评分（MIS）。53名患者在研究期间死亡。存活者的nPCR显著高于（1.10 ± 0.24 g/kg/d vs. 1.01 ± 0.21 g/kg/d; p = 0.048），能量摄入（26.7 ± 5.8 kcal/kg vs. 24.3 ± 4.2 kcal/kg; p = 0.009）和蛋白质摄入（0.91 ± 0.21 g/kg vs. 0.82 ± 0.24 g/kg; p = 0.020）和较低的MIS（5.2 ± 2.3 vs. 6.1 ± 2.1，p = 0.039）。在多变量分析中，能量摄入<25 kcal/kg（HR 1.860，95% CI 1.018-3.399; p = 0.044）和MIS > 5（HR 2.146，95% CI 1.173-3.928; p = 0.013）是与全因死亡率相关的独立变量。这些结果表明，较高的MIS和较低的能量摄入对维持性血液透析的ESRD患者有害。最佳的能量摄入可以降低这些患者的死亡率。
Protein-energy wasting (PEW) is associated with mortality in patients with end-stage renal disease (ESRD) on maintenance hemodialysis. The correct diagnosis of PEW is extremely important in order to predict clinical outcomes. However, it is unclear which parameters should be used to diagnose PEW. Therefore, this retrospective observational study investigated the relationship between mortality and nutritional parameters in ESRD patients on maintenance hemodialysis. A total of 144 patients were enrolled. Nutritional parameters, including body mass index, serum albumin, dietary intake, normalized protein catabolic rate (nPCR), and malnutrition inflammation score (MIS), were measured at baseline. Fifty-three patients died during the study. Survivors had significantly higher nPCR (1.10 ± 0.24 g/kg/day vs. 1.01 ± 0.21 g/kg/day; p = 0.048), energy intake (26.7 ± 5.8 kcal/kg vs. 24.3 ± 4.2 kcal/kg; p = 0.009) and protein intake (0.91 ± 0.21 g/kg vs. 0.82 ± 0.24 g/kg; p = 0.020), and lower MIS (5.2 ± 2.3 vs. 6.1 ± 2.1, p = 0.039). In multivariable analysis, energy intake <25 kcal/kg (HR 1.860, 95% CI 1.018–3.399; p = 0.044) and MIS > 5 (HR 2.146, 95% CI 1.173–3.928; p = 0.013) were independent variables associated with all-cause mortality. These results suggest that higher MIS and lower energy intake are harmful to ESRD patients on maintenance hemodialysis. Optimal energy intake could reduce mortality in these patients.