title: Protein nutrition index as a function of patient survival rate in peritoneal dialysis.
abstract: 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.
authors.affiliation: Division of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
authors.forename: Kuan-Hsing
authors.initials: KH
authors.lastname: Chen
authors.forename: Ching-Herng
authors.initials: CH
authors.lastname: Wu
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Chen
authors.forename: Shu-Man
authors.initials: SM
authors.lastname: Weng
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Hung
mesh_terms: 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
chemical_list: D004044:Dietary Proteins