Diagnosis and prevalence of protein-energy wasting and its association with mortality in Japanese haemodialysis patients

作者：Kanazawa Yoshie; Nakao Toshiyuki^*; Murai Seizo; Okada Tomonari; Matsumoto Hiroshi

来源：Nephrology, 2017, 22(7): 541-547.

DOI：10.1111/nep.12814

• body mass index
• haemodialysis
• protein-energy wasting

AimThe International Society of Renal Nutrition and Metabolism (ISRNM) has proposed the diagnostic criteria for protein-energy wasting (PEW). We studied Japanese haemodialysis (HD) patients to verify the diagnostic method, especially with respect to the body mass index (BMI) criterion, as well as the prevalence of PEW and its association with mortality.
MethodsJapanese patients receiving maintenance HD at three outpatient clinics in Tokyo (n=210) were enrolled, and prospectively followed-up for 3years. PEW was diagnosed at baseline, according to the four categories (serum chemistry, body mass, muscle mass and dietary intake) recommended by the ISRNM. For the category of body mass, we select a body mass index (BMI) and set up three thresholds, <18.5, <20.0 and <23.0kg/m(2), as the diagnostic criterion. The patients who satisfied at least three out of the four categories were diagnosed as PEW.
ResultsProtein-energy wasting, when the threshold of a BMI among the diagnostic criteria was defined as <18.5kg/m(2), was recognized as an independent risk factor for mortality. However, PEW was not recognized as a risk factor when the BMI diagnostic criterion was set at <20.0 or <23.0kg/m(2). Overall, 14.8% of the patients had PEW. The survival rate of PEW patients was significantly lower than that of non-PEW patients (log rank, P<0.001).
ConclusionsThe diagnosis algorithm of PEW proposed by an expert panel of the ISRNM strongly associates with mortality. However, given differences in body size in Japan, we suggest to revise the BMI criterion from <23.0kg/m(2) to <18.5kg/m(2).

• 出版日期2017-7