title: Predictors of protein-energy wasting in haemodialysis patients: a cross-sectional study.
abstract: BACKGROUND
  Protein-energy wasting (PEW) is a highly prevalent condition in haemodialysis patients (HD). The potential usefulness of nutritional-inflammatory markers in the diagnosis of PEW in chronic kidney disease has not been established completely. We hypothesised that a combination of serum albumin, percentage of mid-arm muscle circumference and standard body weight comprises a better discriminator than either single marker of nutritional status in HD patients.
  
  
  METHODS
  A cross-sectional study was performed in 80 HD patients. Patients were categorised in two groups: well-nourished and PEW. Logistic regression analysis was applied to corroborate the reliability of the three markers of PEW with all the nutritional-inflammatory markers analysed.
  
  
  RESULTS
  PEW was identified in 52.5% of HD patients. Compared with the well-nourished patients, PEW patients had lower body mass index, serum pre-albumin and body cell mass (all P < 0.001) and higher C-reactive protein (s-CRP) (P < 0.01). Logistic regression analyses showed that the combination of the three criteria were significantly related with s-CRP >1 mg dL(-1) , phase angle <4°, and serum pre-albumin <30 mg dL(-1) (all P < 0.05). Other indicators, such as lymphocytes <20% and Charlson comorbidity index, were significantly involved (both P < 0.01). A receiver operating characteristic curve (area under the curve) of 0.86 (P < 0.001) was found.
  
  
  CONCLUSIONS
  The combined utilisation of serum albumin, percentage of mid-arm muscle circumference and standard body weight as PEW markers appears to be useful for nutritional-inflammatory status assessment and adds predictive value to the traditional indicators. Larger studies are needed to achieve the reliability of these predictor combinations and their cut-off values in HD patients and other populations.
authors.affiliation: Departamento de Nutrición Humana y Dietética, Facultad de Ciencias de la Salud, Universidad Alfonso X el Sabio, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Ruperto
authors.affiliation: Departamento de Nutrición y Bromatología I (Nutrición), Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Sánchez-Muniz
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Princesa, Madrid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Barril
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D002097:C-Reactive Protein / Q000378:metabolism; D002100:Cachexia / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000175:diagnosis*; D006435:Renal Dialysis / Q000009:adverse effects*; D015203:Reproducibility of Results; D012709:Serum Albumin / Q000378:metabolism; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D002097:C-Reactive Protein
keywords: haemodialysis; inflammation; malnutrition; muscle wasting; nutritional assessment; protein-energy wasting