Abstract: SA-PO1073
New Nutritional Risk Index on the Basis of Protein Energy Wasting for Japanese Hemodialysis Patients
Session Information
- Diet and Nutrition: Clinical
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Kanda, Eiichiro, Kawasaki Medical School, Wakoshi, Saitama, Japan
- Kato, Akihiko, Hamamatsu University Hospital, Hamamatsu, SHIZUOKA, Japan
- Masakane, Ikuto, Honcho-Yabuki Clinic, Yamagata, Japan
- Kanno, Yoshihiko, Tokyo Medical University, Tokyo, Japan
Background
Because the criteria for protein energy wasting (PEW), which is a risk factor for death, are not necessarily appropriate for Asian hemodialysis patients, we developed a new nutritional risk index for one-year all-cause death of Japanese maintenance hemodialysis patients on the basis of the concept of PEW, and evaluated their prognosis.
Methods
We analyzed data from a nation-wide prospective cohort study of the Japanese Society for Dialysis Therapy Renal Data Registry to develop and validate a nutritional risk index (n=48349, 48349, respectively). The association of nutritional factors with one-year death was tested using Cox proportional hazards models. Their cutoff levels were determined from the hazard ratios or receiver operating characteristic curves. Then, risk index was developed using scoring models.
Results
Male was 61.5 %; average age, 65.7±12.2 years; and diabetes mellitus, 32.7 %. Four clinical factors were retained in the final model: low BMI (<20kg/m2), yes=3, no=0; low serum albumin level (young <3.5g/dL; old <3.7g/dL), yes=4, no=0; abnormal serum total cholesterol level, low (<130mg/dL)=1, high (220≥mg/dL)=2, no=0; low serum creatinine level (young female, <9.7mg/dL; old female, <8.0mg/dL; young male, <11.6mg/dL; old male, <9.7mg/dL), yes=4, no=0. In the validation dataset (n=48349), medium- and high-risk groups (total score 8 to 10; 11 or more) showed a higher risk of all-cause death than the low-risk group (0 to 7): medium-risk group (10.5%), hazard ratio adjusted for baseline characteristics 1.96 (95% confidence interval 1.77, 2.16); high-risk group (8.2%), 3.91 (3.57, 4.29) (Figure 1). The medium- and high-risk groups also showed a higher risk of cardiovascular disease- and infection-caused deaths than the low-risk group.
Conclusion
We developed a new nutritional risk index for hemodialysis patients, which may be useful for identifying patients with PEW at an increased risk of death for early treatment.