title: Outcome predictability of biomarkers of protein-energy wasting and inflammation in moderate and advanced chronic kidney disease.
abstract: BACKGROUND
  Markers of protein-energy wasting (PEW) and inflammation are common in chronic kidney disease (CKD) and are among the strongest predictors of mortality in dialysis patients.
  
  
  OBJECTIVE
  We hypothesized that markers of PEW and inflammation show similar associations in patients with non-dialysis-dependent CKD (NDD-CKD).
  
  
  METHODS
  We examined the associations of serum albumin, white blood cell (WBC) count, percentage of lymphocytes in WBCs (%LYM), and a combination of all 3 with all-cause mortality and with the composite of predialysis mortality or end-stage renal disease (ESRD) by using fixed-covariate and time-dependent Cox models in 1220 men with NDD-CKD.
  
  
  RESULTS
  Lower albumin and %LYM and a higher WBC count were significantly associated with outcomes. In time-dependent Cox models, compared with patients in whom none of these markers indicated PEW, those in whom 1, 2, or all 3 markers indicated the presence of PEW had multivariable-adjusted hazard ratios (95% CI) for all-cause mortality of 1.7 (1.2, 2.4), 2.4 (1.7, 3.4), and 3.6 (2.5, 5.1); the P for trend was <0.001. Similar associations were present in fixed-covariate models for all-cause mortality and in fixed-covariate and time-dependent models for the composite outcome.
  
  
  CONCLUSIONS
  Traditional and nontraditional markers of PEW display robust, strong, and independent associations with mortality in patients with NDD-CKD. Clinical trials are warranted to examine whether PEW-improving interventions can lead to better outcomes in these patients.
authors.affiliation: Salem VA Medical Center, Salem, VA 24153, USA. csaba.kovesdy@va.gov
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.forename: Sajid M
authors.initials: SM
authors.lastname: George
authors.forename: John E
authors.initials: JE
authors.lastname: Anderson
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D018450:Disease Progression; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000209:etiology / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011502:Protein-Energy Malnutrition / Q000097:blood* / Q000209:etiology / Q000401:mortality; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D012709:Serum Albumin