Acta Scientific Nutritional Health (ASNH)(ISSN: 2582-1423)

Research Article Volume 6 Issue 1

Low Prevalence of Protein Energy Wasting in Advanced Chronic Kidney Disease Patients Managed with a Nutritional Monitoring Program

Guillermina Barril*, Angel Nogueira, Graciela Alvarez, Almudena Nuñez, Carmen Sanchez and Paula Romasco

Department of Nephrology, Hospital Universitario de la Princesa, Madrid, Spain

*Corresponding Author: Guillermina Barril, Department of Nephrology, Hospital Universitario de la Princesa, Madrid, Spain.

Received: November 18, 2021; Published: December 14, 2021

Abstract

Objectives: To analyze the prevalence of Protein Energy Wasting (PEW) in Advanced Chronic Kidney Patients (ACKD) using monitoring tools normally used in the multidisciplinary CKD Unit. To assess the differences in nutritional parameters, body composition and muscle strength between patients with and without PEW.

Design and Method: Retrospective cross sectional study of patients from the ACKD Unit. The study included outpatient consultations offering specialized care for ACKD in the multidisciplinary hospital unit. We performed an initial nutritional assessment with screening and a complete baseline assessment followed by screening at each consultation (minimum every 3 months) and complete assessment every 6 months or if malnutrition appeared in the screening of risk. We performed screening and complete evaluation with biochemical parameters, body composition assessed by vectorial-bioimpedance and anthropometry, and hand grip strength measurement. PEW was diagnosed according to international society of renal nutrition and metabolism (ISRNM) criteria.

Results: We found a PEW prevalence of 9.1% (29/320 patients) without significant differences between men and women. The mean age of the patients with PEW was higher than that of non-PEW patients (74.58 ± 12.84 vs 70.54 ± 12.37), although the difference was not statistically significant.

We observed significant differences in biochemical parameters, vectorial bioimpedance and anthropometric values, and hand grip strength between patients with and without PEW. A multivariate regression analysis showed that age, transferrin, % fat-free-mass, % total body water and phase-angle were predictive factors for PEW. Of them, phase angle was the best predictive factor.

Conclusions: The use of nutritional status monitoring protocols results in low prevalence of PEW and allows its early detection, thereby favoring the reversion of this condition with the appropriate intervention. An adequate nutritional status monitoring is a priority for the integral care of patients at ACKD Units.

Keywords: Advanced Chronic Kidney Disease Unit (ACKD); Protein Energy Wasting (PEW); Malnutrition; Inflammation

References

  1. Lopes AA., et al. “Independent and joint associations of nutritional status indicators with mortality risk among chronic hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)”. Journal of Renal Nutrition4 (2010): 224-234.
  2. Hyun YY., et al. “Nutritional Status in Adults with Predialysis Chronic Kidney Disease: KNOW-CKD Study”. Journal of Korean Medical Science2 (2017): 257-263.
  3. Fouque D., et al. “A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease”. Kidney International 73 (2008): 391-398.
  4. Kovesdy CP., et al. “Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy”. The American Journal of Clinical Nutrition 97 (2013): 1163-1177.
  5. Moreau-Gaudry X., et al. “A simple protein-energy wasting score predicts survival in maintenance hemodialysis patients”. Journal of Renal Nutrition Official Journal of the Council on Renal Nutrition of the National Kidney Foundation 24 (2014): 395-400.
  6. Carrero JJ., 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)”. Journal of Renal Nutrition 23 (2013): 77-90.
  7. Ramy M Hanna., et al. “A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients”. Blood Purification 49 (2020): 202-211.
  8. De Mutsert R., et al. “Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients”. American Journal of Clinical Nutrition 89 (2009): 787-793.
  9. Sum SS-M., 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”. Journal of Renal Nutrition Official Journal of the Council on Renal Nutrition of the National Kidney Foundation 27 (2017): 325-332.
  10. Vegine PM., et al. “Assessment of methods to identify protein-energy wasting in patients on hemodialysis”. Brazilian Journal of Nephrology Orgao of Soc Bras E Lat-Am Nefrol 33 (2011): 55-61.
  11. Laetitia Koppe., et al. “Kidney cachexia or protein-energy wasting in chronic kidney disease: facts and numbers”. Journal of Cachexia, Sarcopenia and Muscle 10 (2019): 479-484.
  12. Dai L., et al. “Clinical global assessment of nutritional status as predictor of mortality in chronic kidney disease patients”. PLoS ONE 12 (2017): e0186659.
  13. Pérez-Torres A., et al. “Protein-energy wasting syndrome in advanced chronic kidney disease: prevalence and specific clinical characteristics”. Nefrologia (England Ed) 38 (2018): 141-151.
  14. Campbell KL., et al. “Evaluation of nutrition assessment tolos compared with body cell mass for the assessment of malnutrition in chronic kidney disease”. Journal of Renal Nutrition Official Journal of the Council on Renal Nutrition of the National Kidney Foundation 17 (2007): 189-195.
  15. Cupisti A., et al. “Nutritional status and dietary manipulation in predialysis chronic renal failure patients”. Journal of Renal Nutrition Official Journal of the Council on Renal Nutrition of the National Kidney Foundation 14 (2004): 127-133.
  16. Kim JC., et al. “Frailty and protein-energy wasting in elderly patients with end stage kidney disease”. Journal of the American Society of Nephrology3 (2013): 337-351.
  17. Carrero JJ., et al. “Global prevalence of protein-energy wasting in kidney disease: a meta-analysis of contemporary observational studies from the international society of renal nutrition and metabolism”. Journal of Renal Nutrition Official Journal of the Council on Renal Nutrition of the National Kidney Foundation 28 (2018): 380-392.
  18. Gracia-Iguacel C., et al. “Prevalencia del desgaste proteico-energético y su asociación con mortalidad en pacientes en hemodiálisis en un centro de España”. Nefrología4 (2013): 495-505.
  19. Ruperto M., et al. “Predictors of protein-energy wasting in haemodialysis patients: a cross-sectional study”. Journal of Human Nutrition and Dietetics1 (2014): 38-47.
  20. Wang XH and Mitch WE. “Mechanisms of muscle wasting in chronic kidney disease”. Nature Reviews Nephrology 10 (2014): 504-516.
  21. Obi Y., et al. “Latest consensus and update on proteinenergy wasting in chronic kidney disease”. Current Opinion in Clinical Nutrition and Metabolic Care3 (2015): 254-262.
  22. Evans WJ., et al. “Cachexia: a new definition”. Clinical nutrition (Edinburgh, Scotland) 27 (2008): 793-799.
  23. John SG., et al. “Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study”. PLoS One5 (2013): e65372.
  24. De Mutsert R., et al. “Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients”. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc 23 (2008): 2957-2964.
  25. Sharma R., et al. “Association of IL-6, IL-10, and TNF-α gene polymorphism with malnutrition inflammation syndrome and survival among end stage renal disease patients”. Official Journal of Interferon and Cytokine Research 33 (2013): 384-391.
  26. Vanholder R., et al. “Biochemical and Clinical Impact of Organic Uremic Retention Solutes: A Comprehensive Update”. Toxins1 (2018): 33.
  27. Cruz-Jentoft AJ., et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. “Sarcopenia: revised European consensus on definition and diagnosis”. Age Ageing1 (2019): 16-31.
  28. Saitoh M., et al. “Bioelectrical impedance analysis-derived phase angle as a determinant of protein-energy wasting and frailty in maintenance hemodialysis patients: retrospective cohort study”. BMC Nephrology1 (2020): 438.
  29. Barril A., et al. “Influence of dietary protein intake on body composition in CKD patients in stages 3-5: A cross sectional study”. Nefrologia 34 (2018): 647-654.
  30. Garlini LM., et al. “Phase angle and mortality: a systematic review”. European Journal of Clinical Nutrition4 (2019): 495-508.
  31. Fatin Athirah Pauzi., et al. “Exploring Metabolic Signature of Protein Energy Wasting in Hemodialysis Patients”. Metabolites 10 (2020): 291.
  32. Sostisso CF., et al. “Handgrip strength as an instrument for assessing the risk of malnutrition and inflammation in hemodialysis patients”. Brazilian Journal of Nephrology 4 (2020): 429-436.
  33. Oliveira MC., et al. “Handgrip strength in end stage of renal disease. a narrative review”. Nutrients 43 (2018): 14.

Citation

Citation: Guillermina Barril., et al. “Low Prevalence of Protein Energy Wasting in Advanced Chronic Kidney Disease Patients Managed with a Nutritional Monitoring Program". Acta Scientific Nutritional Health 6.1 (2022): 19-27.

Copyright

Copyright: © 2022 Guillermina Barril., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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