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Impact of protein energy wasting status on survival among Afro-Caribbean hemodialysis patients: a 3-year prospective study.

Foucan L, Merault H, Velayoudom-Cephise FL, Larifla L, Alecu C, Ducros J - Springerplus (2015)

Bottom Line: Cox regression analyses were used.Forty deaths (18.5 %) occurred, 97.5 % with a CV cause.Among the PEW markers, low serum albumin (HR 3.18; P = 0.001) and low BMI (HR 1.97; P = 0.034) were the most significant predictors of death.

View Article: PubMed Central - PubMed

Affiliation: Centre de dialyse AUDRA, Hôpital RICOU, Pointe-À-Pitre, Guadeloupe France ; Département de Santé Publique, Equipe de recherche Epidémiologie Clinique et Médecine ECM/LAMIA, EA 4540, Centre Hospitalier Universitaire, Université des Antilles et de la Guyane, CHU de Pointe-à-Pitre, 97159 Pointe-à-Pitre, Guadeloupe France.

ABSTRACT

Background: We assessed the prognostic value of protein-energy wasting (PEW) on mortality in Afro-Caribbean MHD patients and analysed how diabetes, cardiovascular disease (CVD) and inflammation modified the predictive power of a severe wasting state.

Method: A 3-year prospective study was conducted in 216 patients from December 2011. We used four criteria from the nomenclature for PEW proposed by the International Society of Renal Nutrition and Metabolism in 2008: serum albumin 38 g/L, body mass index (BMI) ≤23 kg/m(2), serum creatinine ≤818 µmol/L and protein intake assessed by nPCR ≤0.8 g/kg/day. PEW status was categorized according the number of criteria. Cox regression analyses were used.

Results: Forty deaths (18.5 %) occurred, 97.5 % with a CV cause. Deaths were distributed as follows: 7.4 % in normal nutritional status, 13.2 % in slight wasting (1 PEW criterion), 28 % in moderate wasting (2 criteria) and 50 % in severe wasting (3-4 criteria). Among the PEW markers, low serum albumin (HR 3.18; P = 0.001) and low BMI (HR 1.97; P = 0.034) were the most significant predictors of death. Among the PEW status categories, moderate wasting (HR 3.43; P = 0.021) and severe wasting (HR 6.59; P = 0.001) were significant predictors of death. Diabetes, CVD, and inflammation were all additives in predicting death in association with severe wasting with a strongest HR (7.76; P < 0.001) for diabetic patients.

Conclusions: The nomenclature for PEW predicts mortality in our Afro-Caribbean MHD patients and help to identify patients at risk of severe wasting to provide adequate nutritional support.

No MeSH data available.


Related in: MedlinePlus

Severe wasting (at least three criteria for PEW) and additive markers (diabetes, previous cardiovascular event and inflammation) as predictors of all causes of mortality. PEW protein energy wasting, CVD previous cardiovascular disease, Inflam inflammation. Patients were divided into four groups according to PEW (presence/absence) and the additive factor (presence/absence). Model 1: adjustment for age, sex, diabetes and inflammation. Model 2: adjustment for age, sex, previous cardiovascular event and inflammation. Model 3: adjustment for age, sex, diabetes and previous cardiovascular event
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Fig2: Severe wasting (at least three criteria for PEW) and additive markers (diabetes, previous cardiovascular event and inflammation) as predictors of all causes of mortality. PEW protein energy wasting, CVD previous cardiovascular disease, Inflam inflammation. Patients were divided into four groups according to PEW (presence/absence) and the additive factor (presence/absence). Model 1: adjustment for age, sex, diabetes and inflammation. Model 2: adjustment for age, sex, previous cardiovascular event and inflammation. Model 3: adjustment for age, sex, diabetes and previous cardiovascular event

Mentions: Since cardiovascular disease, diabetes mellitus and inflammation contribute to the high death rate in HD patients, we evaluated the potential additive effects of these co morbid factors on severe wasting (Fig. 2). These factors are all additives in predicting death in our HD patients but, diabetes appears as the strongest predictive factor of death in association with severe wasting. In comparing to patients without severe wasting and without diabetes, patients who had these both factors exhibited a HR of death of 7.76 (P < 0.001) whereas this HR was 2.25 (P < 0.184) for patients having a severe wasting but no diabetes and 2.13 (P < 0.052) for those having diabetes but no severe wasting.Fig. 2


Impact of protein energy wasting status on survival among Afro-Caribbean hemodialysis patients: a 3-year prospective study.

Foucan L, Merault H, Velayoudom-Cephise FL, Larifla L, Alecu C, Ducros J - Springerplus (2015)

Severe wasting (at least three criteria for PEW) and additive markers (diabetes, previous cardiovascular event and inflammation) as predictors of all causes of mortality. PEW protein energy wasting, CVD previous cardiovascular disease, Inflam inflammation. Patients were divided into four groups according to PEW (presence/absence) and the additive factor (presence/absence). Model 1: adjustment for age, sex, diabetes and inflammation. Model 2: adjustment for age, sex, previous cardiovascular event and inflammation. Model 3: adjustment for age, sex, diabetes and previous cardiovascular event
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4549366&req=5

Fig2: Severe wasting (at least three criteria for PEW) and additive markers (diabetes, previous cardiovascular event and inflammation) as predictors of all causes of mortality. PEW protein energy wasting, CVD previous cardiovascular disease, Inflam inflammation. Patients were divided into four groups according to PEW (presence/absence) and the additive factor (presence/absence). Model 1: adjustment for age, sex, diabetes and inflammation. Model 2: adjustment for age, sex, previous cardiovascular event and inflammation. Model 3: adjustment for age, sex, diabetes and previous cardiovascular event
Mentions: Since cardiovascular disease, diabetes mellitus and inflammation contribute to the high death rate in HD patients, we evaluated the potential additive effects of these co morbid factors on severe wasting (Fig. 2). These factors are all additives in predicting death in our HD patients but, diabetes appears as the strongest predictive factor of death in association with severe wasting. In comparing to patients without severe wasting and without diabetes, patients who had these both factors exhibited a HR of death of 7.76 (P < 0.001) whereas this HR was 2.25 (P < 0.184) for patients having a severe wasting but no diabetes and 2.13 (P < 0.052) for those having diabetes but no severe wasting.Fig. 2

Bottom Line: Cox regression analyses were used.Forty deaths (18.5 %) occurred, 97.5 % with a CV cause.Among the PEW markers, low serum albumin (HR 3.18; P = 0.001) and low BMI (HR 1.97; P = 0.034) were the most significant predictors of death.

View Article: PubMed Central - PubMed

Affiliation: Centre de dialyse AUDRA, Hôpital RICOU, Pointe-À-Pitre, Guadeloupe France ; Département de Santé Publique, Equipe de recherche Epidémiologie Clinique et Médecine ECM/LAMIA, EA 4540, Centre Hospitalier Universitaire, Université des Antilles et de la Guyane, CHU de Pointe-à-Pitre, 97159 Pointe-à-Pitre, Guadeloupe France.

ABSTRACT

Background: We assessed the prognostic value of protein-energy wasting (PEW) on mortality in Afro-Caribbean MHD patients and analysed how diabetes, cardiovascular disease (CVD) and inflammation modified the predictive power of a severe wasting state.

Method: A 3-year prospective study was conducted in 216 patients from December 2011. We used four criteria from the nomenclature for PEW proposed by the International Society of Renal Nutrition and Metabolism in 2008: serum albumin 38 g/L, body mass index (BMI) ≤23 kg/m(2), serum creatinine ≤818 µmol/L and protein intake assessed by nPCR ≤0.8 g/kg/day. PEW status was categorized according the number of criteria. Cox regression analyses were used.

Results: Forty deaths (18.5 %) occurred, 97.5 % with a CV cause. Deaths were distributed as follows: 7.4 % in normal nutritional status, 13.2 % in slight wasting (1 PEW criterion), 28 % in moderate wasting (2 criteria) and 50 % in severe wasting (3-4 criteria). Among the PEW markers, low serum albumin (HR 3.18; P = 0.001) and low BMI (HR 1.97; P = 0.034) were the most significant predictors of death. Among the PEW status categories, moderate wasting (HR 3.43; P = 0.021) and severe wasting (HR 6.59; P = 0.001) were significant predictors of death. Diabetes, CVD, and inflammation were all additives in predicting death in association with severe wasting with a strongest HR (7.76; P < 0.001) for diabetic patients.

Conclusions: The nomenclature for PEW predicts mortality in our Afro-Caribbean MHD patients and help to identify patients at risk of severe wasting to provide adequate nutritional support.

No MeSH data available.


Related in: MedlinePlus