title: Diagnosis and prevalence of protein-energy wasting and its association with mortality in Japanese haemodialysis patients.
abstract: OBJECTIVE
  The International Society of Renal Nutrition and Metabolism (ISRNM) has proposed the diagnostic criteria for protein-energy wasting (PEW). We studied Japanese haemodialysis (HD) patients to verify the diagnostic method, especially with respect to the body mass index (BMI) criterion, as well as the prevalence of PEW and its association with mortality.
  
  
  METHODS
  Japanese patients receiving maintenance HD at three outpatient clinics in Tokyo (n = 210) were enrolled, and prospectively followed-up for 3 years. PEW was diagnosed at baseline, according to the four categories (serum chemistry, body mass, muscle mass and dietary intake) recommended by the ISRNM. For the category of body mass, we select a body mass index (BMI) and set up three thresholds, <18.5, <20.0 and <23.0 kg/m2, as the diagnostic criterion. The patients who satisfied at least three out of the four categories were diagnosed as PEW.
  
  
  RESULTS
  Protein-energy wasting, when the threshold of a BMI among the diagnostic criteria was defined as <18.5 kg/m2, was recognized as an independent risk factor for mortality. However, PEW was not recognized as a risk factor when the BMI diagnostic criterion was set at <20.0 or <23.0 kg/m2. Overall, 14.8% of the patients had PEW. The survival rate of PEW patients was significantly lower than that of non-PEW patients (log rank, P < 0.001).
  
  
  CONCLUSIONS
  The diagnosis algorithm of PEW proposed by an expert panel of the ISRNM strongly associates with mortality. However, given differences in body size in Japan, we suggest to revise the BMI criterion from <23.0 kg/m2to <18.5 kg/m2.
authors.affiliation: Tokyo Kaseigakuin University, Tokyo, Japan.|Organization for Kidney Metabolic Disease Treatment, Tokyo, Japan.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Kanazawa
authors.affiliation: Organization for Kidney Metabolic Disease Treatment, Tokyo, Japan.|Bousei Shinjuku Minamiguchi Clinic, Tokyo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakao
authors.affiliation: Iidabashi Murai Iin, Tokyo, Japan.
authors.forename: Seizo
authors.initials: S
authors.lastname: Murai
authors.affiliation: Department of Nephrology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Tomonari
authors.initials: T
authors.lastname: Okada
authors.affiliation: Nakano Minamiguchi Clinic, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D015992:Body Mass Index; D004435:Eating; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D014041:Tokyo / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: body mass index; haemodialysis; protein-energy wasting