Protein nutrition index as a function of patient survival rate in peritoneal dialysis.
OBJECTIVE
Protein-energy wasting (PEW) is a well-known risk factor of long-term survival in peritoneal dialysis (PD) patients. Serum albumin is a measure of visceral protein, lean body mass is a measure of somatic protein stores and normalized protein nitrogen appearance is a measure of daily protein intake. A protein nutrition index (PNI) that combined these 3 factors was designed and tested as a function of survival in PD patients.


METHODS
We enrolled 552 PD patients for this study. Demographic, biochemical, nutritional markers, comorbidity and dialysis-related data were obtained. The PNI was calculated. All patients were followed up to investigate the risks for mortality.


RESULTS
Patients with probable PEW/low-average nutrition were older and had lower serum creatinine (Cr) and blood urea nitrogen, lower adequacy data and higher D4/P4 Cr compared with patients with high-average/good nutrition. 108 patients (19.6%) died during the observational period. By multivariate analysis, we found only age, comorbidity index and PNI (relative risk = 0.84, confidence interval: 0.76-0.93, p = 0.001) to be independent predictors of mortality.


CONCLUSIONS
The PNI at the start of PD is associated with all-cause mortality, and each increase by a score of 1 in PNI leads to a 16% decrease in the risk of mortality. Predialysis evaluation of this scoring system is recommended for further research in order to improve outcomes in PD patients.
Chen
Kuan-Hsing
KH
Division of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
Wu
Ching-Herng
CH
Hsu
Ching-Wei
CW
Chen
Yu-Ming
YM
Weng
Shu-Man
SM
Yang
Chih-Wei
CW
Hung
Cheng-Chieh
CC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004044:Dietary Proteins / Q000008:administration & dosage / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015596:Nutrition Assessment; D009752:Nutritional Status / Q000502:physiology*; D010530:Peritoneal Dialysis / Q000401:mortality* / Q000639:trends; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
D004044:Dietary Proteins