Effects of Protein-Energy Wasting (PEW) and hyperphosphatemia on the prognosis in Japanese maintenance hemodialysis patients: A five-year follow-up observational study
Effects of Protein-Energy Wasting (PEW) and hyperphosphatemia on the prognosis in Japanese maintenance hemodialysis patients: A five-year follow-up observational study
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蛋白质能量消耗（PEW）和高磷血症对日本维持性血液透析患者预后的影响：一项为期五年的随访观察研究
DOI：
10.1016/j.clnesp.2020.01.004
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发表时间：
2020
影响因子：
3
通讯作者：
Hamada Yasuhiro
中科院分区：
文献类型：
--
作者：
Inoue Arisa;Ishikawa Eiji;Shirai Yumiko;Murata Tomohiro;Miki Chikao;Hamada Yasuhiro
背景与目的在透析患者中，营养不良是一个预后不良的因素。在慢性肾脏疾病（CKD）患者中，营养不良与一般营养不良有质的不同，一般营养不良被定义为“蛋白质-能量消耗（PEW）”。增强PEW的饮食疗法需要积极摄入蛋白质。相反，由于蛋白质摄入量和磷摄入量呈正相关，增加蛋白质摄入量会增加磷摄入量，这是透析患者的不良预后因素。透析患者高磷血症的治疗方法之一是通过饮食咨询限制磷的摄入。然而，蛋白质摄取以维持和增强营养状态和蛋白质摄入限制以纠正高磷血症是矛盾的治疗。因此，本研究旨在探讨PEW和高磷血症对血液透析患者预后的影响。MethodsWe招募了60名门诊患者，他们在伊加市立综合医院（日本三重县）接受了6个月（2012年5月至11月）的维持性血液透析。在2012年11月，我们评估了PEW和高磷血症患者的存在或不存在，并评估了生存率在未来5 years.ResultsOverall，10例（17%）被诊断为PEW。平均血磷> 6.0mg/dL者17例（28%）。PEW组的5年生存率为30%，非PEW组为66%，高磷血症组为57%，非高磷血症组为61%。PEW组和非PEW组之间存在统计学显著差异（P= 0.021）。然而，我们没有观察到显着差异之间的高磷血症和非高磷血症groups.ConclusionsThis研究表明，PEW影响的预后比高磷血症在维持性血液透析患者。通过限制蛋白质摄入使血磷水平正常化可预防继发性甲状旁腺功能亢进和血管钙化。相反，限制蛋白质摄入量会造成营养不良的风险。事实上，在这项研究中，早期死亡发生在PEW患者中。也许，PEW患者应该优先改善他们的营养状况，而不是控制血清磷水平。
Background & aimsIn dialysis patients, malnutrition is a poor prognostic factor. In patients with chronic kidney disease (CKD), malnutrition is qualitatively different from general malnutrition, which is defined as “Protein-Energy Wasting (PEW).” Dietary therapy for the enhancement of PEW requires the aggressive intake of protein. Conversely, as protein intake and phosphorus intake correlate positively, increasing the protein intake increases the phosphorus intake, which is a poor prognostic factor in dialysis patients. One of the treatments for hyperphosphatemia in dialysis patients is the intake restriction of phosphorus by dietary counseling. However, protein uptake to maintain and augment the nutritional status and the protein intake restriction to correct hyperphosphatemia are contradictory treatments. Hence, this study aims to investigate the effects of PEW and hyperphosphatemia on the prognosis in hemodialysis patients.MethodsWe enrolled 60 outpatients who underwent maintenance hemodialysis for 6 months (May–November 2012) at Iga City General Hospital (Mie, Japan). In November 2012, we assessed the presence or absence of PEW and hyperphosphatemia in patients and evaluated the survival rate over the next 5 years.ResultsOverall, 10 patients (17%) were diagnosed as PEW. While 17 patients (28%) exhibited average phosphorus level >6.0 mg/dL (hyperphosphatemia). The 5-year survival rate was 30% in the PEW group, 66% in the non-PEW group, 57% in the hyperphosphatemia group, and 61% in the non-hyperphosphatemia group. A statistically significant difference existed between the PEW and non-PEW groups (P= 0.021). However, we observed no significant difference between the hyperphosphatemia and non-hyperphosphatemia groups.ConclusionsThis study suggests that PEW affects the prognosis more than hyperphosphatemia in maintenance hemodialysis patients. The normalization of the serum phosphorus level by the protein intake restriction could prevent secondary hyperparathyroidism and vascular calcification. Conversely, restricting the protein intake poses a risk of malnutrition. In fact, early death occurred in patients with PEW in this study. Perhaps, patients with PEW should prioritize improving their nutritional status rather than controlling the serum phosphorus level.