ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO1073

New Nutritional Risk Index on the Basis of Protein Energy Wasting for Japanese Hemodialysis Patients

Session Information

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.