Predictors of protein‐energy wasting in haemodialysis patients: a cross‐sectional study

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.