Association between modified simple protein-energy wasting (PEW) score and all-cause mortality in patients receiving mai
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(2020) 6:39
RESEARCH
Open Access
Association between modified simple protein-energy wasting (PEW) score and allcause mortality in patients receiving maintenance hemodialysis Shunsuke Yamada1, Toshiaki Nakano1* , Shoji Tsuneyoshi1, Hokuto Arase1, Sho Shimamoto1, Masatomo Taniguchi2, Masanori Tokumoto3, Hideki Hirakata2, Hiroaki Ooboshi3, Kazuhiko Tsuruya4 and Takanari Kitazono1
Abstract Background: Protein-energy wasting (PEW) is a frequently observed complication that leads to increased mortality in hemodialysis patients. However, a multifaceted assessment of PEW by combined objective nutritional parameters has not yet been established. Methods: In total, 144 Japanese patients receiving maintenance hemodialysis at a hemodialysis center were retrospectively followed for 7 years. The primary outcome was all-cause death. The main exposure was a modified simple PEW score (0, 1, 2, 3, or 4), calculated from four parameters: serum albumin and creatinine levels, normalized protein catabolic rate, and body mass index. These parameters are included in the subcategories of PEW as defined by the International Society of Renal Nutrition and Management. The cutoff values of the modified simple PEW score components were based on the receiver operating characteristics curves determined by univariate logistic regression analyses. Risk estimates for all-cause mortality were calculated by the Cox proportional hazards model adjusted for potential confounding factors. Results: During the median 5.7-years follow-up period, 37 patients died of any cause. When patients were divided into three subgroups (G1–G3) based on the modified simple PEW score, a multivariable-adjusted analysis showed that the risks of all-cause death in groups G2 and G3 were significantly higher than in the lowest score group (G1), with hazard risk (95% confidence interval) 3.10 (1.16–8.26) (P = 0.024) and 5.68 (1.85–17.45) (P = 0.002), respectively. Conclusions: The modified simple PEW score is a useful composite indicator of nutritional status that stratifies the risk of all-cause mortality in patients undergoing maintenance hemodialysis. Keywords: Albumin, Body mass index, Creatinine, Hemodialysis, Normalized protein catabolic rate, Protein energy wasting
* Correspondence: [email protected] 1 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 8128582, Japan Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the m
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