Correlation of Various Methods of Assessment of Protein Energy Wasting and their Values as Predictors of Morbidity and Hospitalization in Maintenance Hemodialysis Patients “Protein Energy Wasting in Hemodialysis”
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- Category: Vol. 85, June 2017
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Correlation of Various Methods of Assessment of Protein Energy Wasting and their Values as Predictors of Morbidity and Hospitalization in Maintenance Hemodialysis Patients “Protein Energy Wasting in Hemodialysis”, HEBA W. EL-SAID, TAMER W. EL-SAID, HOWAYDA ZIDAN, SHERIN A. EL-MASRY and HALA M. ALI
Abstract
Background: This study aimed to compare the predictive power of various markers of nutrition and Protein Energy Wasting (PEW) in Maintenance Hemodialysis Patients (MHD) and prospec-tively evaluate the best markers of morbidity and hospitalization risk in protein energy wasted MHD patients.
Methods: Eighty MHD patients were studied. Nutritional status at the baseline of the study was assessed with regard to PEW diagnosis criteria for Chronic Kidney Disease (CKD) based on the recommendations of the International Society of Renal Nutrition and Metabolism (ISRNM). Validated Malnutrition Inflammation Score (MIS) and Bioimpedance Analysis (BIA) were also used for further nutritional assess-ment of patients. BIA was performed 30 minutes after a HD session and the Phase Angle (PA), Body Cell Mass (BCM) and body fat precent values were recorded. The correlation between methods was assessed through Pearson's correlation co-efficient and Receiver Operating Characteristics (ROC) curve.
Results: 66.3% had PEW based on ISRNM criteria. Serum albumin, PA, BCM and MIS were best predictors of PEW by logistic regression analysis. The best predictive accuracy (99.2%) was obtained by the combination of all four afore-mentioned components of PEW; sensitivity 96.2%, specificity 98.4%, positive predictive value 99.4%, negative predictive value 93.04% and Area Under Curve (AUC) (0.85, p<0.001). Furthermore, patients with a lower phase angle, BCM% and higher MIS had a higher hospitalization rate and time.
Conclusion: We recommend that MIS, BIA, anthropomet-ric measures, and biochemical markers be used in combination for best accuracy in diagnosis and evaluation of the nutritional status of ESRD patients.