Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism

Juan J. Carrero, Fridtjof Thomas, Kristóf Nagy, Fatiu Arogundade, Carla M. Avesani, Maria Chan, Michal Chmielewski, Antonio C. Cordeiro, Angeles Espinosa-Cuevas, Enrico Fiaccadori, Fitsum Guebre-Egziabher, Rosa K. Hand, Adriana M. Hung, Talat A. Ikizler, Lina R. Johansson, Kamyar Kalantar-Zadeh, Tilakavati Karupaiah, Bengt Lindholm, Peter Marckmann, Denise MafraRulan S. Parekh, Jongha Park, Sharon Russo, Anita Saxena, Siren Sezer, Daniel Teta, Pieter M. ter Wee, Cecile Verseput, Angela Y. M. Wang, Hong Xu, Yimin Lu, Miklos Z. Molnar, Csaba P. Kovesdy

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Objective: To better define the prevalence of protein-energy wasting (PEW) in kidney disease is poorly defined. Methods: We performed a meta-analysis of PEW prevalence from contemporary studies including more than 50 subjects with kidney disease, published during 2000-2014 and reporting on PEW prevalence by subjective global assessment or malnutrition-inflammation score. Data were reviewed throughout different strata: (1) acute kidney injury (AKI), (2) pediatric chronic kidney disease (CKD), (3) nondialyzed CKD 3-5, (4) maintenance dialysis, and (5) subjects undergoing kidney transplantation (Tx). Sample size, period of publication, reporting quality, methods, dialysis technique, country, geographical region, and gross national income were a priori considered factors influencing between-study variability. Results: Two studies including 189 AKI patients reported a PEW prevalence of 60% and 82%. Five studies including 1776 patients with CKD stages 3-5 reported PEW prevalence ranging from 11% to 54%. Finally, 90 studies from 34 countries including 16,434 patients on maintenance dialysis were identified. The 25th-75th percentiles range in PEW prevalence among dialysis studies was 28-54%. Large variation in PEW prevalence across studies remained even when accounting for moderators. Mixed-effects meta-regression identified geographical region as the only significant moderator explaining 23% of the observed data heterogeneity. Finally, two studies including 1067 Tx patients reported a PEW prevalence of 28% and 52%, and no studies recruiting pediatric CKD patients were identified. Conclusion: By providing evidence-based ranges of PEW prevalence, we conclude that PEW is a common phenomenon across the spectrum of AKI and CKD. This, together with the well-documented impact of PEW on patient outcomes, justifies the need for increased medical attention.
Original languageEnglish
Pages (from-to)380-392
JournalJournal of Renal Nutrition
Issue number6
Publication statusPublished - 2018

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