Kidney Week

Abstract: FR-PO817

Differences in Subjective Global Assessment Score and Mortality Risk Across Race and Ethnicity in a Prospective Hemodialysis Cohort

Session Information

• Health Maintenance, Nutrition, Metabolism - II
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Yoon, Ji Hoon, University of California Irvine School of Medicine, Irvine, California, United States

Ji Hoon Yoon,

• Narasaki, Yoko, University of California Irvine School of Medicine, Irvine, California, United States

Yoko Narasaki,

• You, Seungsook, University of California Irvine School of Medicine, Irvine, California, United States

Seungsook You,

• Okazaki, Masaki, University of California Irvine School of Medicine, Irvine, California, United States

Masaki Okazaki,

• Ismail, Adnan M., University of California Irvine School of Medicine, Irvine, California, United States

Adnan M. Ismail,

• Tran, Diana, University of California Irvine School of Medicine, Irvine, California, United States

Diana Tran,

• Siu, Man Kit Michael, University of California Irvine School of Medicine, Irvine, California, United States

Man Kit Michael Siu,

• Kalantar, Sara S., University of California Irvine School of Medicine, Irvine, California, United States

Sara S. Kalantar,

• Kumar, Parth, University of California Irvine School of Medicine, Irvine, California, United States

Parth Kumar,

• Torres Rivera, Silvina, University of California Irvine School of Medicine, Irvine, California, United States

Silvina Torres Rivera,

• Nguyen, Danh V., University of California Irvine School of Medicine, Irvine, California, United States

Danh V. Nguyen,

• Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States

Kamyar Kalantar-Zadeh,

• Rhee, Connie, University of California Irvine School of Medicine, Irvine, California, United States

Connie Rhee,

Background

Protein-energy wasting is a major predictor of mortality in advanced CKD patients, and clinical guidelines endorse use of the Subjective Global Assessment (SGA) survey as a validated measure of nutritional status in HD patients. We examined the relationship between SGA score and survival in a diverse HD cohort and how associations differ across race/ethnicity.

Methods

We evaluated 1018 HD patients from the prospective NIH MADRAD Study recruited across 18 dialysis clinics who underwent protocolized SGA surveys over 10/2011-12/2021. Using Cox models adjusted for expanded case-mix+laboratory covariates, we examined associations of time-dependent and baseline SGA score categorized as tertiles with all-cause mortality risk. We then examined differential SGA score—mortality associations across race/ethnicity using interaction tests.

Results

The mean±SD age of the cohort was 55±14 years, among whom 44% were female; and 53%, 27%, 10%, and 9% were Hispanic, Non-Hispanic (NH) Black, Asian, and NH White. In analyses of time-dependent SGA score, incrementally higher (worse) tertiles were associated with higher mortality (ref: Tertile 1): HRs (95%CIs) 1.41 (1.07, 1.87) and 2.68 (2.06, 3.48), respectively, for Tertiles 2 and 3, respectively (Fig). Similar findings were observed in baseline SGA analyses. Subgroup analyses showed that Tertile 3 of time-dependent SGA scores were associated with higher mortality in all racial/ethnic groups, with the strongest point estimates observed in Hispanic and NH White patients: HRs (95%CIs) 1.91 (1.59, 2.30), 1.47 (1.19, 1.82), 1.50 (1.01, 2.24), and 2.07 (1.29, 3.32) for Hispanic, NH Black, Asian, and NH White patients, respectively (p-interaction <0.001).

Conclusion

In a multicenter prospective HD cohort, higher (worse) SGA scores were associated with worse survival in all racial/ethnic groups. Further studies are needed to determine personalized approaches to optimizing nutritional status in diverse HD populations.

Funding

• NIDDK Support