TY - JOUR
T1 - 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
AU - Carrero, Juan J.
AU - Thomas, Fridtjof
AU - Nagy, Kristóf
AU - Arogundade, Fatiu
AU - Avesani, Carla M.
AU - Chan, Maria
AU - Chmielewski, Michal
AU - Cordeiro, Antonio C.
AU - Espinosa-Cuevas, Angeles
AU - Fiaccadori, Enrico
AU - Guebre-Egziabher, Fitsum
AU - Hand, Rosa K.
AU - Hung, Adriana M.
AU - Ikizler, Talat A.
AU - Johansson, Lina R.
AU - Kalantar-Zadeh, Kamyar
AU - Karupaiah, Tilakavati
AU - Lindholm, Bengt
AU - Marckmann, Peter
AU - Mafra, Denise
AU - Parekh, Rulan S.
AU - Park, Jongha
AU - Russo, Sharon
AU - Saxena, Anita
AU - Sezer, Siren
AU - Teta, Daniel
AU - ter Wee, Pieter M.
AU - Verseput, Cecile
AU - Wang, Angela Y. M.
AU - Xu, Hong
AU - Lu, Yimin
AU - Molnar, Miklos Z.
AU - Kovesdy, Csaba P.
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85055098982&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30348259
U2 - https://doi.org/10.1053/j.jrn.2018.08.006
DO - https://doi.org/10.1053/j.jrn.2018.08.006
M3 - Article
C2 - 30348259
SN - 1051-2276
VL - 28
SP - 380
EP - 392
JO - Journal of Renal Nutrition
JF - Journal of Renal Nutrition
IS - 6
ER -