Kidney Week

Abstract: SA-PO167

The Discrepancy in the Predictability of Subjective Global Assessment for Mortality According to Dialysis Vintage in Hemodialysis Patients

Session Information

• Nutrition, Inflammation, Metabolism: Clinical Trials, Biomarkers, Epidemiology
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Nutrition, Inflammation, and Metabolism

• 1401 Nutrition, Inflammation, Metabolism

Authors

• Ko, Ye Eun, Ewha Womans University, Seoul, Korea (the Republic of)

Ye Eun Ko,

• Yun, Taeyoung, Ewha womans university, Seoul, Korea (the Republic of)

Taeyoung Yun,

• Ryu, Dong-Ryeol, Ewha Womans University, Seoul, Korea (the Republic of)

Dong-Ryeol Ryu,

Background

Subjective Global Assessment (SGA) is used to gauge nutritional status in dialysis patients. Still, SGA is not reliable for predicting mortality. There is no study on the predictability of SGA regarding mortality between incident and prevalent hemodialysis (HD) patients.

Methods

A total of 2,798 dialysis patients were enrolled from CRC for end-stage renal disease between May 2009 and December 2015. The cohort was divided into two groups: incident (n=1,481) and prevalent HD (n=1,317). Each was stratified into two groups based on SGA: ‘Good nutrition (G1)’ and ‘Mild to severe malnutrition (G2).’ Kaplan-Meier (KM) and multivariate Cox analyses were performed to evaluate the relation between SGA and mortality in each HD group. Prevalent HD patients were divided into ‘short-term’ and ‘long-term’ groups based on median dialysis duration (36.7months), and multivariate Cox analyses were conducted. Incident HD patients were divided based on the presence of diabetes mellitus, age of 65 years or older, and obesity (BMI≥25 kg/m²). The relationship between SGA and mortality was further examined in sub-analyses.

Results

During a median 3.1 years of follow-up period, 590 (21.1%) patients died. The KM survival curve showed that the cumulative survival rate in G1 was significantly higher than that in G2 among all patients (P<0.001) as well as in each group stratified based on dialysis vintage (P<0.001). Multivariate Cox analyses revealed that G2 was significantly associated with an increase in mortality (HR; 1.27, 95%CI; 1.10-1.47, P=0.002) compared with G1 among all patients. G2 was also significantly related to an increase in mortality in prevalent HD patients, but not incident HD patients (HR; 1.33, 95%CI; 1.01-1.75, P=0.04). Yet, in short-term, not long-term prevalent patients, G2 was significantly associated with an increase in mortality compared to G1 (HR; 1.52, 95%CI; 1.04-2.24, P=0.03). There were no significant relations between the SGA and mortality in the sub-analysis among incident HD patients.

Conclusion

Nutrition status according to SGA might be helpful for predicting mortality especially in prevalent HD patients, whereas SGA alone do not reflect the adverse clinical outcomes in incident HD patients. Further evaluation is needed to determine the discrepancy in association with mortality between two HD populations.