<strong>Background:</strong> Malnutrition is a strong predictor of prognosis in maintenance hemodialysis patients (MHD). We previously proposed a new and simple protein-energy wasting (PEW) score that appe...<strong>Background:</strong> Malnutrition is a strong predictor of prognosis in maintenance hemodialysis patients (MHD). We previously proposed a new and simple protein-energy wasting (PEW) score that appears to be useful for assessing the risk of mortality in patients on MHD. <strong>Objectives: </strong>In the present study, we evaluated the reliability of this PEW score as a predictor of hospitalization in Japanese patients on MHD. <strong>Methods:</strong> In this single-center, prospective cohort study conducted in Japan, PEW score was calculated for 180 MHD patients. PEW score ranged from 0 (best: S1) to 4 (worst: S4) and was calculated based on nutritional indicators including serum albumin, body mass index, serum creatinine level, and protein intake. The outcome was the number of hospitalizations during the 2-year study period. <strong>Results:</strong> Thirty-six patients were hospitalized during the study period. Kaplan-Meier curves showed there were fewer hospitalizations in the group with a PEW score of 0/1 than in the group with a score of 3/4. Multivariate analysis revealed a hazard ratio for hospitalization of 3.109 for S3/4 versus S0, 2.777 for S3/4 versus S1, and 2.048 for S3/4 versus S2.<strong> Conclusion:</strong> The new and simple PEW score is a useful predictor of hospitalization in MHD patients and is also useful for identifying subgroups of MHD patients with a high risk of mortality.展开更多
Protein energy wasting (PEW) is a major challenge in CKD. Objective: To assess PEW in predialysis patients on their first visit to a nephrologist. Methods: Three day dietary intake of 484 CKD stage 3 patients was take...Protein energy wasting (PEW) is a major challenge in CKD. Objective: To assess PEW in predialysis patients on their first visit to a nephrologist. Methods: Three day dietary intake of 484 CKD stage 3 patients was taken. Appetite was assessed with ADAT. Patients were divided into groups based on appetite and BMI. Results: Male and female parameters are serum albumin 3.7 ± 0.84/3.68.8 ± 0.81 g/dL, total protein 7.02 ± 1.27/6.94 ± 1.26 g/dL, creatinine 4.68 ± 4.19/3.74 ± 3.36 mg% creatinine clearance 33.22 ± 30.48/37.55 ± 33.87 ml/minute, BMI 22.60 ± 4.29/23.43 ± 4.77kg/m2 energy/kg 16.97 ± 0.65/16.8 ± 0.64, protein g/kg 0.65 ± 0.28/0.64 ± 0.30, carbohydrate g/kg 2.98 ± 1.54/2.98 ± 0.1.36, fat g/kg 2.98 ± 0.23/2.79 ± 0.22, respectively. As appetite decreased, dietary protein and energy intake decreased significantly. Appetite in males and females: Average 14.46%, 4.13%, poor 9.7%, 18.18%, anorexic 13.2%, 7.4%. Income had strong correlation with BMI (p 0.000), dietary protein (p 0.000), energy (p 0.000) and carbohydrate (p 0.000). Appetite correlated with creatinine (p 0.019), dietary energy, protein, carbohydrate and fat (p 0.000) intake. BMI correlated (p 0.000) with fat, carbohydrate, energy and creatinine clearance. ANOVA showed significant difference within and between appetite groups in energy, protein, fat, carbohydrate, creatinine clearance (p 0.000) and serum albumin (p 0.025). There was significant difference in protein (p 0.026), energy intake (p 0.000) and creatinine clearance (p 0.038) within and between BMI groups. Based on income, there was significant difference among groups in BMI (p 0.000), energy (p 0.019), protein (p 0.031) and albumin (0.001).展开更多
文摘<strong>Background:</strong> Malnutrition is a strong predictor of prognosis in maintenance hemodialysis patients (MHD). We previously proposed a new and simple protein-energy wasting (PEW) score that appears to be useful for assessing the risk of mortality in patients on MHD. <strong>Objectives: </strong>In the present study, we evaluated the reliability of this PEW score as a predictor of hospitalization in Japanese patients on MHD. <strong>Methods:</strong> In this single-center, prospective cohort study conducted in Japan, PEW score was calculated for 180 MHD patients. PEW score ranged from 0 (best: S1) to 4 (worst: S4) and was calculated based on nutritional indicators including serum albumin, body mass index, serum creatinine level, and protein intake. The outcome was the number of hospitalizations during the 2-year study period. <strong>Results:</strong> Thirty-six patients were hospitalized during the study period. Kaplan-Meier curves showed there were fewer hospitalizations in the group with a PEW score of 0/1 than in the group with a score of 3/4. Multivariate analysis revealed a hazard ratio for hospitalization of 3.109 for S3/4 versus S0, 2.777 for S3/4 versus S1, and 2.048 for S3/4 versus S2.<strong> Conclusion:</strong> The new and simple PEW score is a useful predictor of hospitalization in MHD patients and is also useful for identifying subgroups of MHD patients with a high risk of mortality.
文摘Protein energy wasting (PEW) is a major challenge in CKD. Objective: To assess PEW in predialysis patients on their first visit to a nephrologist. Methods: Three day dietary intake of 484 CKD stage 3 patients was taken. Appetite was assessed with ADAT. Patients were divided into groups based on appetite and BMI. Results: Male and female parameters are serum albumin 3.7 ± 0.84/3.68.8 ± 0.81 g/dL, total protein 7.02 ± 1.27/6.94 ± 1.26 g/dL, creatinine 4.68 ± 4.19/3.74 ± 3.36 mg% creatinine clearance 33.22 ± 30.48/37.55 ± 33.87 ml/minute, BMI 22.60 ± 4.29/23.43 ± 4.77kg/m2 energy/kg 16.97 ± 0.65/16.8 ± 0.64, protein g/kg 0.65 ± 0.28/0.64 ± 0.30, carbohydrate g/kg 2.98 ± 1.54/2.98 ± 0.1.36, fat g/kg 2.98 ± 0.23/2.79 ± 0.22, respectively. As appetite decreased, dietary protein and energy intake decreased significantly. Appetite in males and females: Average 14.46%, 4.13%, poor 9.7%, 18.18%, anorexic 13.2%, 7.4%. Income had strong correlation with BMI (p 0.000), dietary protein (p 0.000), energy (p 0.000) and carbohydrate (p 0.000). Appetite correlated with creatinine (p 0.019), dietary energy, protein, carbohydrate and fat (p 0.000) intake. BMI correlated (p 0.000) with fat, carbohydrate, energy and creatinine clearance. ANOVA showed significant difference within and between appetite groups in energy, protein, fat, carbohydrate, creatinine clearance (p 0.000) and serum albumin (p 0.025). There was significant difference in protein (p 0.026), energy intake (p 0.000) and creatinine clearance (p 0.038) within and between BMI groups. Based on income, there was significant difference among groups in BMI (p 0.000), energy (p 0.019), protein (p 0.031) and albumin (0.001).
文摘目的通过持续质量改进(continuous quality improvement,CQI)的管理方法来干预维持性血液透析患者的蛋白质-能量消耗并探讨其影响。方法选取2016年7月至2017年6月在江阴市人民医院血液净化中心行常规血液透析的85例存在蛋白质-能量消耗(protein-energy wasting,PEW)的患者,建立持续质量改进团队及应用持续质量改进方案,管理对象包括患者及其家属,先后在治疗过程中实施“PDCA”[计划(plan)、实施(do)、检验(check)、应用(act)]步骤,观察期为12个月,比较持续质量改进前后的血清白蛋白(serum albumin,Alb)、血清前白蛋白(pre-albumin,PA)、转铁蛋白(transferrin,TF)、血清胆固醇(serum cholesterol,Tch)、血红蛋白(hemoglobin,Hb)、血肌酐(serum creatinine,Scr)、尿素氮(urea nitrogen,BUN)、血清超敏C反应蛋白(serum hypersensitive c-reactive protein Hs-CRP)、体重指数(body mass index,BMI)、中臂围(midarm circumference,MAC)、中臂肌围(mid-arm circumference,MAMC)、标准化蛋白代谢率(normalized protein catabolic rate,nPCR)、血钙、血磷、全段甲状旁腺素水平(intact parathyroid hormone,iPTH)、改良主观综合营养评估(modified quantitative and global assessment,MQSGA)。观察持续质量改进对这些指标的影响。结果在持续质量改进后,Alb(g/L)、PA(mg/L)、TF(mg/L)、Tch(mmol/L)、Hb(g/L)、BMI(kg/m^(2))水平均较前上升,分别为34.34±3.97比37.26±3.33、252.9±41.7比295.1±39.0、1.52±0.24比1.99±0.25、2.93±0.84比4.23±0.97、83.88±16.75比94.12±13.46、27.58±6.84比28.16±5.78,且均P<0.05,差异有统计学意义。Scr、BUN水平在CQI前后改变不大(t=0.161,P=0.873、t=0.549,P=0.588)。Hs-CRP水平由(20.85±2.09)mg/L下降至(13.15±1.74)mg/L(t=5.02,P<0.01)。在营养指标评估方面,MAC由(22.02±1.63)mm上升至(24.81±1.26)mm(t=5.02,P<0.01),MAMC由(20.68±1.47)mm上升至(22.74±1.40)mm(t=2.603,P=0.017),nPCR由(0.85±0.92)g·kg^(-1)·d^(-1)上升至(1.21±0.21)g·kg^(-1)·d^(-1)(t=1.154,P=0.022),MQSGA轻度比例由77.65%升至88.23%(χ^(2)=4.61,P=0.002),中度比例由18.82%降至10.59%(χ^(2)=3.69,P=0.017),重度比例由3.50%降至1.33%(χ^(2)=5.05,P<0.001)。血钙水平前后波动较小(t=0.629,P=0.537),达标比例由52.0%上升至66.7%(χ^(2)=2.36,P<0.05);血磷平均水平由(2.11±0.24)mmol/L降至(1.80±0.23)mmol/L(t=-0.459,P<0.001),达标比例由19.04%上升至47.62%(χ^(2)=5.13,P<0.001);iPTH水平由(40.79±18.67)pmol/L下降至(24.41±9.82)pmol/L(t=-5.566,P<0.001),达标比例由47.62%上升至71.43%(χ^(2)=4.69,P<0.001)。结论CQI能够显著改善患者的综合营养状况,同时患者的血钙、血磷及iPTH达标比例都得到明显的提升,且没有出现钙磷代谢紊乱,继发性甲状旁腺功能紊乱等状况。
