Protein Nutrition Index as a Function of Patient Survival Rate in Peritoneal Dialysis

• Published in: Kidney & blood pressure research Vol. 33; no. 3; pp. 174 - 180
• Main Authors: Chen, Kuan-Hsing, Wu, Ching-Herng, Hsu, Ching-Wei, Chen, Yu-Ming, Weng, Shu-Man, Yang, Chih-Wei, Hung, Cheng-Chieh
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2010
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Dietary Proteins - administration & dosage; Dietary Proteins - metabolism; Female; Humans; Male; Middle Aged; Mortality - trends; Nutrition Assessment; Nutritional Status - physiology; Original Paper; Peritoneal Dialysis - mortality; Peritoneal Dialysis - trends; Survival Rate - trends; Young Adult; Percent lean body mass; Albumin; Normalized protein nitrogen appearance; Protein energy wasting; Mortality; Peritoneal dialysis
• ISSN: 1420-4096; 1423-0143
• DOI: 10.1159/000316701

Background/Aims: Protein-energy wasting (PEW) is a well-known risk factor of long-term survival in peritoneal dialysis (PD) patients. Serum albumin is a measure of visceral protein, lean body mass is a measure of somatic protein stores and normalized protein nitrogen appearance is a measure of daily protein intake. A protein nutrition index (PNI) that combined these 3 factors was designed and tested as a function of survival in PD patients. Methods: We enrolled 552 PD patients for this study. Demographic, biochemical, nutritional markers, comorbidity and dialysis-related data were obtained. The PNI was calculated. All patients were followed up to investigate the risks for mortality. Results: Patients with probable PEW/low-average nutrition were older and had lower serum creatinine (Cr) and blood urea nitrogen, lower adequacy data and higher D4/P4 Cr compared with patients with high-average/good nutrition. 108 patients (19.6%) died during the observational period. By multivariate analysis, we found only age, comorbidity index and PNI (relative risk = 0.84, confidence interval: 0.76–0.93, p = 0.001) to be independent predictors of mortality. Conclusion: The PNI at the start of PD is associated with all-cause mortality, and each increase by a score of 1 in PNI leads to a 16% decrease in the risk of mortality. Predialysis evaluation of this scoring system is recommended for further research in order to improve outcomes in PD patients.