Global prevalence of protein-energy wasting in kidney disease: A meta-analysis of contemporary observational studies from the international society of renal nutrition and metabolism

Objective: To better define the prevalence of protein-energy wasting (PEW) in kidney disease is poorly defined. Methods: We performed a meta-analysis of PEW prevalence from contemporary studies including more than 50 subjects with kidney disease, published during 2000-2014 and reporting on PEW prevalence by subjective global assessment or malnutrition-inflammation score. Data were reviewed throughout different strata: (1) acute kidney injury (AKI), (2) pediatric chronic kidney disease (CKD), (3) nondialyzed CKD 3-5, (4) maintenance dialysis, and (5) subjects undergoing kidney transplantation (Tx). Sample size, period of publication, reporting quality, methods, dialysis technique, country, geographical region, and gross national income were a priori considered factors influencing between-study variability. Results: Two studies including 189 AKI patients reported a PEW prevalence of 60% and 82%. Five studies including 1776 patients with CKD stages 3-5 reported PEW prevalence ranging from 11% to 54%. Finally, 90 studies from 34 countries including 16,434 patients on maintenance dialysis were identified. The 25th-75th percentiles range in PEW prevalence among dialysis studies was 28-54%. Large variation in PEW prevalence across studies remained even when accounting for moderators. Mixed-effects meta-regression identified geographical region as the only significant moderator explaining 23% of the observed data heterogeneity. Finally, two studies including 1067 Tx patients reported a PEW prevalence of 28% and 52%, and no studies recruiting pediatric CKD patients were identified. Conclusion: By providing evidence-based ranges of PEW prevalence, we conclude that PEW is a common phenomenon across the spectrum of AKI and CKD. This, together with the well-documented impact of PEW on patient outcomes, justifies the need for increased medical attention.

A preliminary report on the functioning and data collection capabilities of a web-based nutrition algorithm for patients with chronic kidney disease.

OBJECTIVE: The purpose of this study was to test the functional and data collection capabilities of an online nutrition algorithm for patients with chronic kidney disease by comparing dietitian-selected nutrition diagnoses, etiologies, and interventions in hemodialysis (HD) patients with and without diabetes mellitus (DM). DESIGN: Data were collected using an online nutrition screening tool and algorithm for HD patients based on the American Dietetic Association's Nutrition Care Process. SETTING: Data were collected by dietitians in the United States, New Zealand, Australia, and Brazil. PATIENTS: Patients undergoing HD under the care of a participating dietitian and who were deemed at nutrition risk at visit 1 were eligible to participate. Other inclusion criteria included age >19 years, able to speak and write English, and not receiving hospice care or the international equivalent. Data were available on 26 patients (50% males, 39% with DM). Mean baseline values were as follows: age, 56.3 years; body mass index, 28.2 kg/m(2); and serum albumin (bromocresol green), 36.8 g/L (3.68 g/dL). There were no statistically significant differences between DM and non-DM patients except in mean hemoglobin A1C. MAIN OUTCOME MEASURE: Differences in the frequency of selection of diagnoses, etiology, and intervention categories were compared. RESULTS: The algorithm is under continuous development using input from participating dietitians, but its use was generally considered feasible. The initial data analysis showed that the algorithm is an effective method for collecting data on HD patients. In this small cohort, patients with and without DM had similar dietitian-selected nutrition diagnoses and etiologies, but had statistically significant differences in the dietitian-selected nutrition interventions that were selected most frequently. Health Care Team Referral was selected more often in DM patients (P < .003) and Recommendation of Specific Foods was selected more often in non-DM patients (P < .0170). CONCLUSION: This preliminary analysis shows that the algorithm can be used as both a clinical and a data collection tool. The test analysis, although small in sample size, showed interesting differences in the care of DM and non-DM HD patients.