A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients

Camiel L M de Roij van Zuijdewijn; Piet M ter Wee; Isabelle Chapdelaine; Michiel L Bots; Peter J Blankestijn; Marinus A van den Dorpel; Menso J Nubé; Muriel P C Grooteman

doi:https://doi.org/10.1053/j.jrn.2015.02.005

A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients

Camiel L M de Roij van Zuijdewijn, Piet M ter Wee, Isabelle Chapdelaine, Michiel L Bots, Peter J Blankestijn, Marinus A van den Dorpel, Menso J Nubé, Muriel P C Grooteman

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVE: Protein-energy wasting (PEW) describes a state of decreased protein and energy fuels and is highly prevalent in hemodialysis patients. As PEW is associated with mortality, it should be detected accurately and easily. This study investigated which nutrition-related test predicts mortality and morbidity best in hemodialysis patients.

DESIGN AND SUBJECTS: Data were used from CONTRAST, a cohort of end-stage kidney disease patients. Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS), Geriatric Nutritional Risk Index (GNRI), composite score of Protein-Energy Nutritional Status (cPENS), serum albumin, serum creatinine, body mass index, and normalized protein nitrogen appearance rate were assessed at baseline. End points were all-cause mortality, cardiovascular events, and infection. Discriminative value of every test was assessed with Harrell's C statistic and calibration tested using the Hosmer-Lemeshow goodness-of-fit test. Ultimately, in every test, 4 groups were created to compare (1) hazard ratios (HR; worst vs best group), (2) HR increase per group, and (3) HR of worst group versus other groups.

RESULTS: In total, 489 patients were analyzed. Median follow-up was 2.97 years (interquartile range, 1.67-4.47 years). MIS, GNRI, albumin, and creatinine discriminated all-cause mortality equally. SGA, cPENS, body mass index, and normalized protein nitrogen appearance were inferior. cPENS and creatinine were inadequately calibrated. Of the remaining tests, GNRI predicted mortality less when comparing HRs. MIS and albumin predicted mortality equally well. In a subanalysis, these also predicted infection equally well, but MIS predicted cardiovascular events better.

CONCLUSION: Of the 8 investigated nutrition-related tests, MIS and albumin predict mortality best in hemodialysis patients. As one has no added value over the other, we conclude that mortality is most easily predicted in hemodialysis patients by serum albumin.

Original language	English
Pages (from-to)	412-9
Number of pages	8
Journal	Journal of Renal Nutrition
Volume	25
Issue number	5
DOIs	https://doi.org/10.1053/j.jrn.2015.02.005
Publication status	Published - Sept 2015

Keywords

Aged
Body Mass Index
Creatinine/blood
Endpoint Determination
Energy Intake
Female
Follow-Up Studies
Geriatric Assessment
Humans
Kidney Failure, Chronic/mortality
Male
Middle Aged
Nutrition Assessment
Nutritional Status
Proportional Hazards Models
Prospective Studies
Protein-Energy Malnutrition/diagnosis
Renal Dialysis/mortality
Risk Factors
Serum Albumin/metabolism

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https://doi.org/10.1053/j.jrn.2015.02.005

Cite this

@article{2d638dd9194b4aef91d29b23b27b4a6e,

title = "A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients",

abstract = "OBJECTIVE: Protein-energy wasting (PEW) describes a state of decreased protein and energy fuels and is highly prevalent in hemodialysis patients. As PEW is associated with mortality, it should be detected accurately and easily. This study investigated which nutrition-related test predicts mortality and morbidity best in hemodialysis patients.DESIGN AND SUBJECTS: Data were used from CONTRAST, a cohort of end-stage kidney disease patients. Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS), Geriatric Nutritional Risk Index (GNRI), composite score of Protein-Energy Nutritional Status (cPENS), serum albumin, serum creatinine, body mass index, and normalized protein nitrogen appearance rate were assessed at baseline. End points were all-cause mortality, cardiovascular events, and infection. Discriminative value of every test was assessed with Harrell's C statistic and calibration tested using the Hosmer-Lemeshow goodness-of-fit test. Ultimately, in every test, 4 groups were created to compare (1) hazard ratios (HR; worst vs best group), (2) HR increase per group, and (3) HR of worst group versus other groups.RESULTS: In total, 489 patients were analyzed. Median follow-up was 2.97 years (interquartile range, 1.67-4.47 years). MIS, GNRI, albumin, and creatinine discriminated all-cause mortality equally. SGA, cPENS, body mass index, and normalized protein nitrogen appearance were inferior. cPENS and creatinine were inadequately calibrated. Of the remaining tests, GNRI predicted mortality less when comparing HRs. MIS and albumin predicted mortality equally well. In a subanalysis, these also predicted infection equally well, but MIS predicted cardiovascular events better.CONCLUSION: Of the 8 investigated nutrition-related tests, MIS and albumin predict mortality best in hemodialysis patients. As one has no added value over the other, we conclude that mortality is most easily predicted in hemodialysis patients by serum albumin.",

keywords = "Aged, Body Mass Index, Creatinine/blood, Endpoint Determination, Energy Intake, Female, Follow-Up Studies, Geriatric Assessment, Humans, Kidney Failure, Chronic/mortality, Male, Middle Aged, Nutrition Assessment, Nutritional Status, Proportional Hazards Models, Prospective Studies, Protein-Energy Malnutrition/diagnosis, Renal Dialysis/mortality, Risk Factors, Serum Albumin/metabolism",

author = "{de Roij van Zuijdewijn}, {Camiel L M} and {ter Wee}, {Piet M} and Isabelle Chapdelaine and Bots, {Michiel L} and Blankestijn, {Peter J} and {van den Dorpel}, {Marinus A} and Nub{\'e}, {Menso J} and Grooteman, {Muriel P C}",

year = "2015",

month = sep,

doi = "https://doi.org/10.1053/j.jrn.2015.02.005",

language = "English",

volume = "25",

pages = "412--9",

journal = "Journal of Renal Nutrition",

issn = "1051-2276",

publisher = "W.B. Saunders Ltd",

number = "5",

}

TY - JOUR

T1 - A Comparison of 8 Nutrition-Related Tests to Predict Mortality in Hemodialysis Patients

AU - de Roij van Zuijdewijn, Camiel L M

AU - ter Wee, Piet M

AU - Chapdelaine, Isabelle

AU - Bots, Michiel L

AU - Blankestijn, Peter J

AU - van den Dorpel, Marinus A

AU - Nubé, Menso J

AU - Grooteman, Muriel P C

PY - 2015/9

Y1 - 2015/9

N2 - OBJECTIVE: Protein-energy wasting (PEW) describes a state of decreased protein and energy fuels and is highly prevalent in hemodialysis patients. As PEW is associated with mortality, it should be detected accurately and easily. This study investigated which nutrition-related test predicts mortality and morbidity best in hemodialysis patients.DESIGN AND SUBJECTS: Data were used from CONTRAST, a cohort of end-stage kidney disease patients. Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS), Geriatric Nutritional Risk Index (GNRI), composite score of Protein-Energy Nutritional Status (cPENS), serum albumin, serum creatinine, body mass index, and normalized protein nitrogen appearance rate were assessed at baseline. End points were all-cause mortality, cardiovascular events, and infection. Discriminative value of every test was assessed with Harrell's C statistic and calibration tested using the Hosmer-Lemeshow goodness-of-fit test. Ultimately, in every test, 4 groups were created to compare (1) hazard ratios (HR; worst vs best group), (2) HR increase per group, and (3) HR of worst group versus other groups.RESULTS: In total, 489 patients were analyzed. Median follow-up was 2.97 years (interquartile range, 1.67-4.47 years). MIS, GNRI, albumin, and creatinine discriminated all-cause mortality equally. SGA, cPENS, body mass index, and normalized protein nitrogen appearance were inferior. cPENS and creatinine were inadequately calibrated. Of the remaining tests, GNRI predicted mortality less when comparing HRs. MIS and albumin predicted mortality equally well. In a subanalysis, these also predicted infection equally well, but MIS predicted cardiovascular events better.CONCLUSION: Of the 8 investigated nutrition-related tests, MIS and albumin predict mortality best in hemodialysis patients. As one has no added value over the other, we conclude that mortality is most easily predicted in hemodialysis patients by serum albumin.

AB - OBJECTIVE: Protein-energy wasting (PEW) describes a state of decreased protein and energy fuels and is highly prevalent in hemodialysis patients. As PEW is associated with mortality, it should be detected accurately and easily. This study investigated which nutrition-related test predicts mortality and morbidity best in hemodialysis patients.DESIGN AND SUBJECTS: Data were used from CONTRAST, a cohort of end-stage kidney disease patients. Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS), Geriatric Nutritional Risk Index (GNRI), composite score of Protein-Energy Nutritional Status (cPENS), serum albumin, serum creatinine, body mass index, and normalized protein nitrogen appearance rate were assessed at baseline. End points were all-cause mortality, cardiovascular events, and infection. Discriminative value of every test was assessed with Harrell's C statistic and calibration tested using the Hosmer-Lemeshow goodness-of-fit test. Ultimately, in every test, 4 groups were created to compare (1) hazard ratios (HR; worst vs best group), (2) HR increase per group, and (3) HR of worst group versus other groups.RESULTS: In total, 489 patients were analyzed. Median follow-up was 2.97 years (interquartile range, 1.67-4.47 years). MIS, GNRI, albumin, and creatinine discriminated all-cause mortality equally. SGA, cPENS, body mass index, and normalized protein nitrogen appearance were inferior. cPENS and creatinine were inadequately calibrated. Of the remaining tests, GNRI predicted mortality less when comparing HRs. MIS and albumin predicted mortality equally well. In a subanalysis, these also predicted infection equally well, but MIS predicted cardiovascular events better.CONCLUSION: Of the 8 investigated nutrition-related tests, MIS and albumin predict mortality best in hemodialysis patients. As one has no added value over the other, we conclude that mortality is most easily predicted in hemodialysis patients by serum albumin.

KW - Aged

KW - Body Mass Index

KW - Creatinine/blood

KW - Endpoint Determination

KW - Energy Intake

KW - Female

KW - Follow-Up Studies

KW - Geriatric Assessment

KW - Humans

KW - Kidney Failure, Chronic/mortality

KW - Male

KW - Middle Aged

KW - Nutrition Assessment

KW - Nutritional Status

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Protein-Energy Malnutrition/diagnosis

KW - Renal Dialysis/mortality

KW - Risk Factors

KW - Serum Albumin/metabolism

U2 - https://doi.org/10.1053/j.jrn.2015.02.005

DO - https://doi.org/10.1053/j.jrn.2015.02.005

M3 - Article

C2 - 25820178

SN - 1051-2276

VL - 25

SP - 412

EP - 419

JO - Journal of Renal Nutrition

JF - Journal of Renal Nutrition

IS - 5

ER -