Clinical global assessment of nutritional status as predictor of mortality in chronic kidney disease patients

PLoS One. 2017 Dec 6;12(12):e0186659. doi: 10.1371/journal.pone.0186659. eCollection 2017.

Abstract

Background: The value of subjective global assessment (SGA) as nutritional assessor of protein-energy wasting (PEWSGA) in chronic kidney disease (CKD) patients depends on its mortality predictive capacity. We investigated associations of PEWSGA with markers of nutritional status and all-cause mortality in CKD patients.

Methods: In 1031 (732 CKD1-5 non-dialysis and 299 dialysis) patients, SGA and body (BMI), lean (LBMI) and fat (FBMI) body mass indices, % handgrip strength (% HGS), serum albumin, and high sensitivity C-reactive protein (hsCRP) were examined at baseline. The five-year all-cause mortality predictive strength of baseline PEWSGA and during follow-up were investigated.

Results: PEWSGA was present in 2% of CKD1-2, 16% of CKD3-4, 31% of CKD5 non-dialysis and 44% of dialysis patients. Patients with PEWSGA (n = 320; 31%) had higher hsCRP and lower BMI, LBMI, FBMI, %HGS and serum albumin. But, using receiver operating characteristics-derived cutoffs, these markers could not classify (by kappa statistic) or explain variations of (by multinomial logistic regression analysis) presence of PEWSGA. In generalized linear models, SGA independently predicted mortality after adjustments of multiple confounders (RR: 1.17; 95% CI: 1.11-1.23). Among 323 CKD5 patients who were re-assessed after median 12.6 months, 222 (69%) remained well-nourished, 37 (11%) developed PEWSGA de novo, 40 (12%) improved while 24 (8%) remained with PEWSGA. The latter independently predicted mortality (RR: 1.29; 95% CI: 1.13-1.46).

Conclusions: SGA, a valid assessor of nutritional status, is an independent predictor of all-cause mortality both in CKD non-dialysis and dialysis patients that outperforms non-composite nutritional markers as prognosticator.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Humans
  • Inflammation / complications
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / mortality*
  • Kidney Failure, Chronic / physiopathology
  • Male
  • Middle Aged
  • Nutritional Status*

Grants and funding

This study was supported by grants from Baxter Healthcare Corporation and Amgen Inc to Karolinska Institutet. The grant from Baxter Healthcare Corporation was a general grant to Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, to support research activities at Karolinska Institutet to promote the understanding and treatment of renal disease which made it possible to carry out this and other studies. The grant from Amgen Inc was given to Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, to support two observational studies on inflammation in dialysis patients treated by hemodialysis and peritoneal dialysis respectively. Lu Dai received a scholarship from the China Scholarship Council. The study also benefited from generous support from Swedish Research council (Peter Stenvinkel), Martin Rind Foundation (Peter Stenvinkel), Njurfonden (Peter Stenvinkel), and Westmans Foundation. Bengt Lindholm is employed by Baxter Healthcare. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.