Abstract
Background: Protein-energy wasting (PEW) is prevalent among hemodialysis (HD) patients and is associated with poor outcomes. There are various methods for evaluating nutritional status in HD patients that each has its own advantages and disadvantages. We aimed at comparing the methods of normalized protein catabolic ratio (nPCR) and malnutrition universal screening tool (MUST) with subjective global assessment (SGA) in HD patients. Method: We examined 88 HD patients using SGA and MUST questionnaires, and also nPCR were calculated using predialysis and post-dialysis BUN, and Kt/v. Also, patients were assessed for PEW based on the Criteria of the International Society of Renal Nutrition and Metabolism. Methods’ specificity, sensitivity, and precision rates were assessed. Correlations between methods were analyzed using Pearson-correlation. Results: Based on the SGA, MUST, and nPCR methods, almost 41, 30, and 60 percent of patients had malnutrition, respectively. According to the criteria by International Society of Renal Nutrition and Metabolism, more than 90 percent of patients had PEW. SGA was positively and significantly associated with MUST (P≤0.001). Sensitivity for SGA, MUST, and nPCR methods were 100,100, 1.8 %, and their specificity were 98, 98, and 4 %, respectively and their precision rates were 99.7, 98.7, and 3%, respectively. Conclusion: From various methods of nutritional assessment (SGA, MUST, and nPCR), compared to SGA as the common method of nutrition assessment in hemodialysis patients, MUST had the nearest specificity, sensitivity, and precision rate compared to SGA and nPCR method had the lowest ones. nPCR seems to be a flawed marker of malnutrition and it should be more investigated whether MUST can be used instead of SGA or not.
A Comparative Analysis of Nutritional Assessment Using Global Leadership Initiative on Malnutrition Versus Subjective Global Assessment and Malnutrition Inflammation Score in Maintenance Hemodialysis Patients