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J Ren Nutr. 2018 May;28(3):165-174. doi: 10.1053/j.jrn.2017.11.002. Epub 2018 Feb 16.

Prevalence and Risk of Protein-Energy Wasting Assessed by Subjective Global Assessment in Older Adults With Advanced Chronic Kidney Disease: Results From the EQUAL Study.

Author information

1
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Nutrition and Dietetics, Department of Orthopaedics, Danderyds Hospital, Stockholm, Sweden.
2
Division of Clinical Geriatrics, Department of NVS, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden.
3
Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
4
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
5
ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
6
Department of Clinical Epidemiology, Leiden University Medical Centre, Leidenthe, The Netherlands.
7
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland.
8
Nephrology, Dialysis and Transplantation Unit and CNR-IFC Research Unit of Reggio Calabria, Reggio Calabria, Italy.
9
Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany.
10
United Kingdom Renal Registry (UKRR), Southmead Hospital, Bristol, United Kingdom; Division of Population Health Sciences, Department of Medical School, University of Bristol, Bristol, United Kingdom.
11
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address: Marie.evans@ki.se.

Abstract

OBJECTIVES:

Prevalence and risk factors for protein-energy wasting (PEW) are poorly studied in the nondialysis, older population with advanced chronic kidney disease (CKD). Our aim was to evaluate the prevalence of PEW in advanced stage CKD patients aged greater than 65 years. Furthermore, we aimed to describe risk factors for PEW in the overall study population and among obese individuals.

DESIGN:

Prospective observational cohort study.

METHODS:

The EQUAL study, a European Quality Study on treatment in advanced chronic kidney disease, is a multicenter prospective observational cohort study in six European countries. We included patients aged ≥65 years with incident glomerular filtration rate <20mL/min/1.73m2 not on dialysis attending nephrology care. PEW was assessed by 7-point Subjective Global Assessment (7-p SGA).

RESULTS:

In general, the study cohort (n = 1,334) was overweight (mean body mass index [BMI] 28.4 kg/m2). The majority of the patients had a normal nutritional status (SGA 6-7), 26% had moderate PEW (SGA 3-5), and less than 1% had severe PEW (SGA 1-2). Muscle wasting and loss of fat tissue were the most frequent alterations according to the SGA subscales, especially in those aged >80 years. The prevalence of PEW was higher among women, increased with age, and was higher in those with depression/dementia. PEW was the most common in those with underweight (BMI <22 kg/m2), 55% or normal weight (BMI 22-25 kg/m2), 40%. In obese individuals (BMI >30 kg/m2), 25% were diagnosed with protein wasting. Risk factors for SGA ≤5 in obese people were similar to those for the overall study population.

CONCLUSION:

This European multicenter study shows that the prevalence of PEW is high in patients with advanced CKD aged >65 years. The risk of PEW increases substantially with age and is commonly characterized by muscle wasting. Our study suggests that focus on nutrition should start early in the follow-up of older adults with CKD.

PMID:
29459026
DOI:
10.1053/j.jrn.2017.11.002

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