Research Article
Kronik Böbrek Hastalıklarında Protein Enerjisi İsrafının Prognostik Önemi: Kesitsel Tek Merkezli Bir Çalışma
Abstract
Amaç: Bu çalışmanın amacı kronik böbrek hastalığı (KBH) olan bireylerde Protein Enerji Kaybı (PEK) sıklığını belirlemek ve PEK ile bireylerin antropometrik ölçümleri, biyokimyasal parametreleri ve beslenme durumları arasındaki ilişkiyi değerlendirmektir.
Yöntem: Çalışma 19 yaş ve üzeri KBH'li 119 diyaliz öncesi birey ile gerçekleştirildi. Katılımcıların biyokimyasal parametreleri ve antropometrik ölçümleri değerlendirilerek beslenme durumları Subjektif Global Değerlendirme (SGD) ve PEK kriteri ile belirlendi. Beslenme durumu SGA'ya göre iyi, orta derecede beslenme yetersizliği ve ciddi beslenme yetersizliği olarak sınıflandırıldı. PEK için ≥3 kategorinin karşılanması durumunda PEK'in varlığı kabul edildi.
Bulgular: SGD'ye göre bireylerin %20,2'sinde orta/ciddi malnütrisyon, %8,4'ünde PEK vardı. Bireylerde PEK kriterlerinin sayısının artmasıyla birlikte vücut ağırlığı, beden kütle indeksi (BKİ), üst orta kol çevresi, triseps deri kıvrım kalınlığı ve vücut yağ yüzdesinin; serum toplam protein, albümin, kalsiyum ve magnezyum düzeyleri; birçok makro ve mikro besinin alım miktarları önemli ölçüde azalmıştır. Bireylerin karşıladığı PEK kriteri sayısını en çok açıklayan parametrelerin BKİ (%26,8), albümin (%18,6), posa (%14,1) ve magnezyum (%15,7) olduğu belirlendi.
Sonuç: PEK antropometrik ölçümler, biyokimyasal parametreler ve besin alımıyla ilişkiliydi. Dolayısıyla tanı anından itibaren PEK aracının belirli aralıklarla kullanılması malnütrisyon prevalansının azaltılmasında pratik ve etkili bir müdahale olacaktır.
References
- 1. Hill NR, Fatoba ST, Oke JL, et al. Global prevalence of chronic kidney disease – a systematic review and meta-analysis. PLoS One. 2016;11(7):e0158765.
- 2. Okunola OO, Erohubie CO, Arogundade FA, et al. The prevalence and pattern of malnutrition in pre-dialytic chronic kidney disease patients at a tertiary care facility in Nigeria. West Afr J Med. 2018;35(3):180-188.
- 3. Oluseyi A, Enajite O. Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria. Afr Health Sci. 2016;16(1):234-241.
- 4. Tayyem RF, Mrayyan MT. Assessing the prevalence of malnutrition in chronic kidney disease patients in jordan. J Ren Nutr. 2008;18(2):202-209.
- 5. Essadik R, Msaad R, Lebrazi H, et al. Assessing the prevalence of protein-energy wasting in haemodialysis patients: A cross-sectional monocentric study. Nephrol Ther. 2017;13:537-543.
- 6. Carrero JJ, Stenvinkel P, Cuppari L, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: A consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013;23(2):77-90.
- 7. Gonzalez-Ortiz AJ, Arce-Santander CV, Vega-Vega O, Correa-Rotter R, Espinosa-Cuevas MA. Assessment of the reliability and consistency of the “Malnutrition Inflammation Score” (MIS) in Mexican adults with chronic kidney disease for diagnosis of protein-energy wasting syndrome (PEW). Nutr Hosp. 2015;31(3):1352-1358.
- 8. Sarav M, Kovesdy CS. Protein energy wasting in hemodialysis patients. Clin J Am Soc Nephrol. 2018;13:1558-1560.
- 9. Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73(4):391-398.
- 10. Antón-Pérez G, Santana-Del-Pino Á, Henríquez-Palop F, et al. Diagnostic usefulness of the protein energy wasting score in prevalent hemodialysis patients. J Ren Nutr. 2018;28(6):428-434.
- 11. Beddhu S, Chen X, Wei G, et al. Associations of protein−energy wasting syndrome criteria with body composition and mortality in the general and moderate chronic kidney disease populations in the United States. Kidney Int Rep. 2017;2(3):390-399.
- 12. Beddhu S, Wei G, Chen X, et al. Associations of dietary protein and energy ıntakes with protein-energy wasting syndrome in hemodialysis patients. Kidney Int Rep. 2017;2(5):821-830.
- 13. Lohman TG, Roche AF, Martorell R, ed(s). Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books Champaign; 1988.
- 14. Bishop CW, Bowen PE, Ritchey SJ. Norms for nutritional assessment of American adults by upper arm anthropometry. Am J Clin Nutr. 1981;34(11):2530–2539.
- 15. Rakıcıoglu N, Tek N, Ayaz A, Pekcan G, ed(s). Food and Nutrition Photo Catalog: Measurements and Quantities. Ankara: Ata Ofset Printing; 2006.
- 16. Gupta D, Lammersfeld CA. Prognostic Significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr. 2005;59(1):35–40.
- 17. Kadiri ME, Nechba RB, Oualim Z. Factors predicting malnutrition in hemodialysis patients. Saudi J Kidney Dis Transpl. 2011;22:695-704.
- 18. Lawson JA, Lazarus R, Kelly JJ. Prevalence and prognostic significance of malnutrition in chronic renal insufficiency. Ren Nutr. 2001;11(1):16-22.
- 19. Prakash J, Raja R, Mishra RN, et al. High prevalence of malnutrition and inflammation in undialyzed patients with chronic renal failure in developing countries: A single centre experience from eastern India. Renal Failure. 2007;29(7):811–816.
- 20. Al-Othman AM, Al-Naseeb AM, Almajwal AM, et al. Association of malnutrition in peritoneal dialysis patients of Saudi Arabia. Arab J Chem. 2006;9(2):1059-1062.
- 21. Avram MM, Fein PA, Rafiq MA, et al. Malnutrition and inflammation as predictors of mortality in peritoneal dialysis patients. Kidney Int. 2006;70(104):4-7.
- 22. De Mutsert R, Grootendorst DC, Axelsson J, et al. Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transplant. 2008;23(9):2957-64.
- 23. Gama-Axelsson T, Heimburger O, Stenvinkel P, Bárány P, Lindholm B, Qureshi AR. Serum albumin as predictor of nutritional status in patients with ESRD. Clin J Am Soc Nephrol. 2012;7(9):1446-53.
- 24. Leinig CE, Moraes T, Ribeiro S, et al. Predictive value of malnutrition markers for mortality in peritoneal dialysis patients. J Ren Nutr. 2011;21(2):176-83.
- 25. Mehrotra S, Rishishwar P, Sharma RK. Malnutrition and hyperphosphatemia in dialysis patients. Clinical Queries: Nephrology. 2015;4(3-4):25-27.
- 26. Hyun YY, Lee KB, Oh KH, et al. Serum adiponectin and protein-energy wasting in predialysis chronic kidney disease. Nutrition. 2017;33:254-260.
- 27. Hyun YY, Lee KB, Han SH, et al. Nutritional status in adults with predialysis chronic kidney disease: KNOW-CKD Study. J Korean Med Sci. 2017;32(2):257-263.
- 28. Jagadeswaran D, Indhumathi E, Hemamalini AJ, Sivakumar V, Soundararajan P, Jayakumar M. Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients. Clin Nutr. 2019;38:341-347.
- 29. Iorember FM. Malnutrition in chronic kidney disease. Front Pediatr. 2018;6:161.
- 30. Dai L, Mukai H, Lindholm B, et al. Clinical global assessment of nutritional status as predictor of mortality in chronic kidney disease patients. PLoS One. 2017;12(12):e0186659.
- 31. Lodebo BT, Shah A, Kopple JD. Is it important to prevent and treat Protein-Energy Wasting in chronic kidney disease and chronic dialysis patients?. J Ren Nutr. 2018;28(6):369-379.
- 32. Cuppari L, Meireles MS, Ramos CI, Kamimura MA. Subjective Global Assessment for the diagnosis of protein–energy wasting in nondialysis-dependent chronic kidney disease patients. J Ren Nutr. 2014;24(6):385-389.
- 33. Sum SSM, Marcus AF, Blair D, et al. Comparison of Subjective Global Assessment and Protein Energy Wasting Score to nutrition evaluations conducted by registered dietitian nutritionists in identifying protein energy wasting risk in maintenance hemodialysis patients. J Ren Nutr. 2017;27(5):325-332.
- 34. Milovanova L, Fomin V, Lysenko L, et al. Nutritional status disorders in chronic kidney disease: Practical aspects (systematic review). In: Rath T, ed. Chronic Kidney Disease-from Pathophysiology to Clinical Improvements. London: IntechOpen; 2018.
- 35. Davis E, Campbell K, Gobe G, Hawley C, Isbel N, Johnson DW. Association of anthropometric measures with kidney disease progression and mortality: A retrospective cohort study of pre-dialysis chronic kidney disease patients referred to a specialist renal service. BMC Nephrol. 2016;17:74.
- 36. Lu JL, Kalantar-Zadeh K, Ma JZ, Quarles LD, Kovesdy CP. Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol. 2014;25(9):2088–96.
- 37. Rymarz A, Szamotulska K, Niemczyk S. Comparison of skinfold thicknesses and bioimpedance spectroscopy to Dual-Energy X-Ray absorptiometry for the body fat measurement in patients with chronic kidney disease. Nutr Clin Pract. 2017;32(4):533-538.
- 38. Windahl K, Faxén Irving G, Almquist T, et al. Prevalence and risk of protein-energy wasting assessed by subjective global assessment in older adults with advanced chronic kidney disease: Results from the EQUAL study. J Ren Nutr. 2018;28(3):165-174.
- 39. Kovesdy CP, Kopple JD, Kalantar-Zadeh K. Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: Reconciling low protein intake with nutritional therapy. Am J Clin Nutr. 2013;97(6):1163-77.
- 40. Kovesdy CP, George SM, Anderson JE, Kalantar-Zadeh K. Outcome predictability of biomarkers of protein-energy wasting and inflammation in moderate and advanced chronic kidney disease. Am J Clin Nutr. 2009;90(2):407-414.
- 41. Włodarek D, Głąbska D, Rojek-Trębicka J. Assessment of diet in chronic kidney disease female predialysis patients. Ann Agric Environ Med. 2014;21(4):829-834.
- 42. Chen ME, Hwang SJ, Chen HC, et al. Correlations of dietary energy and protein intakes with renal function impairment in chronic kidney disease patients with or without diabetes. Kaohsiung J Med Sci. 2017;33(5):252-259.
- 43. Hyun YY, Lee BL, Rhee EJ, Park CY, Chang Y, Ryu S. Chronic kidney disease and high eGFR according to body composition phenotype in adults with normal BMI. Nutr Metab Cardiovasc Dis. 2016;26(12):1088-1095.
- 44. Metzger M, Yuan WL, Haymann JP, et al. Association of a low-protein diet with slower progression of CKD. Kidney Int Rep. 2018;3(1):105-114.
The Prognostic Importance of Protein Energy Wasting in Chronic Kidney Disease: A Sectional Monocentric Study
Abstract
Aim: The purpose of this study is to determine the frequency of Protein Energy Wasting (PEW) in individuals with chronic kidney disease (CKD) and evaluate the relationship between PEW and anthropometric measurements, biochemical parameters, and nutritional status of individuals.
Method: The study was conducted with 119 predialysis individuals aged 19 and over with CKD. The biochemical parameters and anthropometric measurements of the participants were evaluated, and their nutritional status was determined by Subjective Global Assessment (SGA) and PEW criteria. Nutritional status was classified as good, moderate nutritional deficiency, and severe malnutrition according to SGA. The presence of PEW was accepted if ≥3 categories for PEW were met.
Results: According to SGA, 20.2% of the individuals had moderate/severe malnutrition and 8.4% PEW. It was determined that with the increase in the number of PEW criteria in individuals, the body weight, body mass index (BMI), upper middle arm circumference, triceps skin fold thickness and body fat percentage; serum total protein, albumin, calcium and magnesium levels; intake amounts of many macro and micro nutrients have decreased significantly. It was detected that BMI (26.8%), albumin (18.6%), fiber (14.1%) and magnesium (15.7%) were the parameters most explaining the number of PEW criteria met by individuals.
Conclusion: PEW was related to anthropometric measurements, biochemical parameters and nutrient intakes. So, using the PEW tool at certain intervals from the moment of diagnosis will be a practical and effective intervention in reducing the prevalence of malnutrition.
Keywords
Anthropometric measurements nutrition chronic kidney disease malnutrition protein energy wasting
Ethical Statement
The study was approved by the Ankara University Ethics Committee (Date: 18.06.2019, Decision No: 231) and the study was conducted in accordance with the principles of the Declaration of Helsinki.
References
- 1. Hill NR, Fatoba ST, Oke JL, et al. Global prevalence of chronic kidney disease – a systematic review and meta-analysis. PLoS One. 2016;11(7):e0158765.
- 2. Okunola OO, Erohubie CO, Arogundade FA, et al. The prevalence and pattern of malnutrition in pre-dialytic chronic kidney disease patients at a tertiary care facility in Nigeria. West Afr J Med. 2018;35(3):180-188.
- 3. Oluseyi A, Enajite O. Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria. Afr Health Sci. 2016;16(1):234-241.
- 4. Tayyem RF, Mrayyan MT. Assessing the prevalence of malnutrition in chronic kidney disease patients in jordan. J Ren Nutr. 2008;18(2):202-209.
- 5. Essadik R, Msaad R, Lebrazi H, et al. Assessing the prevalence of protein-energy wasting in haemodialysis patients: A cross-sectional monocentric study. Nephrol Ther. 2017;13:537-543.
- 6. Carrero JJ, Stenvinkel P, Cuppari L, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: A consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013;23(2):77-90.
- 7. Gonzalez-Ortiz AJ, Arce-Santander CV, Vega-Vega O, Correa-Rotter R, Espinosa-Cuevas MA. Assessment of the reliability and consistency of the “Malnutrition Inflammation Score” (MIS) in Mexican adults with chronic kidney disease for diagnosis of protein-energy wasting syndrome (PEW). Nutr Hosp. 2015;31(3):1352-1358.
- 8. Sarav M, Kovesdy CS. Protein energy wasting in hemodialysis patients. Clin J Am Soc Nephrol. 2018;13:1558-1560.
- 9. Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73(4):391-398.
- 10. Antón-Pérez G, Santana-Del-Pino Á, Henríquez-Palop F, et al. Diagnostic usefulness of the protein energy wasting score in prevalent hemodialysis patients. J Ren Nutr. 2018;28(6):428-434.
- 11. Beddhu S, Chen X, Wei G, et al. Associations of protein−energy wasting syndrome criteria with body composition and mortality in the general and moderate chronic kidney disease populations in the United States. Kidney Int Rep. 2017;2(3):390-399.
- 12. Beddhu S, Wei G, Chen X, et al. Associations of dietary protein and energy ıntakes with protein-energy wasting syndrome in hemodialysis patients. Kidney Int Rep. 2017;2(5):821-830.
- 13. Lohman TG, Roche AF, Martorell R, ed(s). Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books Champaign; 1988.
- 14. Bishop CW, Bowen PE, Ritchey SJ. Norms for nutritional assessment of American adults by upper arm anthropometry. Am J Clin Nutr. 1981;34(11):2530–2539.
- 15. Rakıcıoglu N, Tek N, Ayaz A, Pekcan G, ed(s). Food and Nutrition Photo Catalog: Measurements and Quantities. Ankara: Ata Ofset Printing; 2006.
- 16. Gupta D, Lammersfeld CA. Prognostic Significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr. 2005;59(1):35–40.
- 17. Kadiri ME, Nechba RB, Oualim Z. Factors predicting malnutrition in hemodialysis patients. Saudi J Kidney Dis Transpl. 2011;22:695-704.
- 18. Lawson JA, Lazarus R, Kelly JJ. Prevalence and prognostic significance of malnutrition in chronic renal insufficiency. Ren Nutr. 2001;11(1):16-22.
- 19. Prakash J, Raja R, Mishra RN, et al. High prevalence of malnutrition and inflammation in undialyzed patients with chronic renal failure in developing countries: A single centre experience from eastern India. Renal Failure. 2007;29(7):811–816.
- 20. Al-Othman AM, Al-Naseeb AM, Almajwal AM, et al. Association of malnutrition in peritoneal dialysis patients of Saudi Arabia. Arab J Chem. 2006;9(2):1059-1062.
- 21. Avram MM, Fein PA, Rafiq MA, et al. Malnutrition and inflammation as predictors of mortality in peritoneal dialysis patients. Kidney Int. 2006;70(104):4-7.
- 22. De Mutsert R, Grootendorst DC, Axelsson J, et al. Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transplant. 2008;23(9):2957-64.
- 23. Gama-Axelsson T, Heimburger O, Stenvinkel P, Bárány P, Lindholm B, Qureshi AR. Serum albumin as predictor of nutritional status in patients with ESRD. Clin J Am Soc Nephrol. 2012;7(9):1446-53.
- 24. Leinig CE, Moraes T, Ribeiro S, et al. Predictive value of malnutrition markers for mortality in peritoneal dialysis patients. J Ren Nutr. 2011;21(2):176-83.
- 25. Mehrotra S, Rishishwar P, Sharma RK. Malnutrition and hyperphosphatemia in dialysis patients. Clinical Queries: Nephrology. 2015;4(3-4):25-27.
- 26. Hyun YY, Lee KB, Oh KH, et al. Serum adiponectin and protein-energy wasting in predialysis chronic kidney disease. Nutrition. 2017;33:254-260.
- 27. Hyun YY, Lee KB, Han SH, et al. Nutritional status in adults with predialysis chronic kidney disease: KNOW-CKD Study. J Korean Med Sci. 2017;32(2):257-263.
- 28. Jagadeswaran D, Indhumathi E, Hemamalini AJ, Sivakumar V, Soundararajan P, Jayakumar M. Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients. Clin Nutr. 2019;38:341-347.
- 29. Iorember FM. Malnutrition in chronic kidney disease. Front Pediatr. 2018;6:161.
- 30. Dai L, Mukai H, Lindholm B, et al. Clinical global assessment of nutritional status as predictor of mortality in chronic kidney disease patients. PLoS One. 2017;12(12):e0186659.
- 31. Lodebo BT, Shah A, Kopple JD. Is it important to prevent and treat Protein-Energy Wasting in chronic kidney disease and chronic dialysis patients?. J Ren Nutr. 2018;28(6):369-379.
- 32. Cuppari L, Meireles MS, Ramos CI, Kamimura MA. Subjective Global Assessment for the diagnosis of protein–energy wasting in nondialysis-dependent chronic kidney disease patients. J Ren Nutr. 2014;24(6):385-389.
- 33. Sum SSM, Marcus AF, Blair D, et al. Comparison of Subjective Global Assessment and Protein Energy Wasting Score to nutrition evaluations conducted by registered dietitian nutritionists in identifying protein energy wasting risk in maintenance hemodialysis patients. J Ren Nutr. 2017;27(5):325-332.
- 34. Milovanova L, Fomin V, Lysenko L, et al. Nutritional status disorders in chronic kidney disease: Practical aspects (systematic review). In: Rath T, ed. Chronic Kidney Disease-from Pathophysiology to Clinical Improvements. London: IntechOpen; 2018.
- 35. Davis E, Campbell K, Gobe G, Hawley C, Isbel N, Johnson DW. Association of anthropometric measures with kidney disease progression and mortality: A retrospective cohort study of pre-dialysis chronic kidney disease patients referred to a specialist renal service. BMC Nephrol. 2016;17:74.
- 36. Lu JL, Kalantar-Zadeh K, Ma JZ, Quarles LD, Kovesdy CP. Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol. 2014;25(9):2088–96.
- 37. Rymarz A, Szamotulska K, Niemczyk S. Comparison of skinfold thicknesses and bioimpedance spectroscopy to Dual-Energy X-Ray absorptiometry for the body fat measurement in patients with chronic kidney disease. Nutr Clin Pract. 2017;32(4):533-538.
- 38. Windahl K, Faxén Irving G, Almquist T, et al. Prevalence and risk of protein-energy wasting assessed by subjective global assessment in older adults with advanced chronic kidney disease: Results from the EQUAL study. J Ren Nutr. 2018;28(3):165-174.
- 39. Kovesdy CP, Kopple JD, Kalantar-Zadeh K. Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: Reconciling low protein intake with nutritional therapy. Am J Clin Nutr. 2013;97(6):1163-77.
- 40. Kovesdy CP, George SM, Anderson JE, Kalantar-Zadeh K. Outcome predictability of biomarkers of protein-energy wasting and inflammation in moderate and advanced chronic kidney disease. Am J Clin Nutr. 2009;90(2):407-414.
- 41. Włodarek D, Głąbska D, Rojek-Trębicka J. Assessment of diet in chronic kidney disease female predialysis patients. Ann Agric Environ Med. 2014;21(4):829-834.
- 42. Chen ME, Hwang SJ, Chen HC, et al. Correlations of dietary energy and protein intakes with renal function impairment in chronic kidney disease patients with or without diabetes. Kaohsiung J Med Sci. 2017;33(5):252-259.
- 43. Hyun YY, Lee BL, Rhee EJ, Park CY, Chang Y, Ryu S. Chronic kidney disease and high eGFR according to body composition phenotype in adults with normal BMI. Nutr Metab Cardiovasc Dis. 2016;26(12):1088-1095.
- 44. Metzger M, Yuan WL, Haymann JP, et al. Association of a low-protein diet with slower progression of CKD. Kidney Int Rep. 2018;3(1):105-114.
There are 44 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Nutrition |
| Journal Section | Articles |
| Authors | |
| Early Pub Date | April 29, 2025 |
| Publication Date | April 29, 2025 |
| Submission Date | July 11, 2024 |
| Acceptance Date | March 20, 2025 |
| Published in Issue | Year 2025 Issue: 25 |
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