Abstract: TH-PO838
Subjective Global Assessment Scores and Survival in a Multi-Center Prospective Hemodialysis Cohort
Session Information
- Health Maintenance, Nutrition, Metabolism
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance‚ Nutrition‚ and Metabolism
- 1400 Health Maintenance‚ Nutrition‚ and Metabolism
Authors
- Yoon, Ji Hoon, University of California Irvine, Irvine, California, United States
- Narasaki, Yoko, University of California Irvine, Irvine, California, United States
- You, Amy Seung, University of California Irvine, Irvine, California, United States
- Torres Rivera, Silvina, University of California Irvine, Irvine, California, United States
- Le, Lisa, University of California Irvine, Irvine, California, United States
- Dang, Anyssa K., University of California Irvine, Irvine, California, United States
- Nguyen, Matthew Duy Thanh Luyen, University of California Irvine, Irvine, California, United States
- Marwaha, Arjun, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Nguyen, Danh V., University of California Irvine, Irvine, California, United States
- Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
- Rhee, Connie, University of California Irvine, Irvine, California, United States
Background
Protein-energy wasting (PEW) is highly prevalent in end-stage kidney disease (ESKD) patients receiving hemodialysis (HD), and is a potent predictor of survival in this population. We sought to conduct Subjective Global Assessment (SGA) surveys, a simple yet validated nutritional assessment instrument, in a prospective cohort of HD patients in order to assess the relationship between PEW and survival in this population.
Methods
In a multi-center prospective cohort of 1018 HD patients from the NIH “Malnutrition, Diet, and Racial Disparities in Kidney Disease (MADRAD)” Study recruited from 18 dialysis clinics who underwent protocolized SGA surveys every 6 months, we examined the relationship between baseline and time-dependent SGA scores with all-cause mortality using multivariable Cox models.
Results
The median (IQR) and min-max of baseline SGA scores were 1 (0, 2) and 0-13, respectively (Fig A). In analyses of baseline SGA scores categorized as quartiles, we observed that incrementally higher SGA quartiles were associated with increasingly higher mortality risk: HRs (95%CIs) 1.37 (1.01, 1.86), 1.65 (1.17, 2.33), and 2.02 (1.55, 2.64) for the second lowest, second highest, and highest quartiles of SGA scores, respectively, in expanded case-mix+laboratory models (Fig B). Analyses of time-dependent SGA scores showed a similar pattern of findings: HRs (95%CIs) 1.27 (0.92, 1.76), 1.53 (1.08, 2.16), and 2.58 (1.98, 3.36) for the second lowest, second highest, and highest quartiles of SGA scores, respectively, in expanded case-mix+laboratory models (Fig C).
Conclusion
In a prospective multi-center cohort of HD patients, increasing severity of PEW ascertained by SGA surveys were associated with incrementally higher death risk. These findings underscore the importance of using the SGA as a practical nutritional assessment tool that can be conveniently applied at the chairside in order to identify HD patients with inadequate dietary intake who may benefit from earlier implementation of nutrition interventions.
Funding
- NIDDK Support