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Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients

Authors
 Young Eun Kwon  ;  Youn Kyung Kee  ;  Chang-Yun Yoon  ;  In Mee Han  ;  Seung Gyu Han  ;  Kyoung Sook Park  ;  Mi Jung Lee  ;  Jung Tak Park  ;  Seung H. Han  ;  Tae-Hyun Yoo  ;  Yong-Lim Kim  ;  Yon Su Kim  ;  Chul Woo Yang  ;  Nam-Ho Kim  ;  Shin-Wook Kang 
Citation
 MEDICINE, Vol.95(7) : 2714, 2016 
Journal Title
 MEDICINE 
ISSN
 0025-7974 
Issue Date
2016
MeSH
Age Factors ; Aged ; Biomarkers ; Body Mass Index ; Female ; Humans ; Kidney Failure, Chronic/mortality* ; Kidney Failure, Chronic/therapy* ; Male ; Middle Aged ; Nutrition Assessment* ; Nutritional Status* ; Proportional Hazards Models ; Prospective Studies ; Protein-Energy Malnutrition/mortality ; Regression Analysis ; Renal Dialysis/statistics & numerical data* ; Risk Factors ; Sex Factors ; Survival Analysis
Abstract
Subjective global assessment (SGA) is associated with mortality in end-stage renal disease (ESRD) patients. However, little is known whether improvement or deterioration of nutritional status after dialysis initiation influences the clinical outcome. We aimed to elucidate the association between changes in nutritional status determined by SGA during the first year of dialysis and all-cause mortality in incident ESRD patients. This was a multicenter, prospective cohort study. Incident dialysis patients with available SGA data at both baseline and 12 months after dialysis commencement (n = 914) were analyzed. Nutritional status was defined as well nourished (WN, SGA A) or malnourished (MN, SGA B or C). The patients were divided into 4 groups according to the change in nutritional status between baseline and 12 months after dialysis commencement: group 1, WN to WN; group 2, MN to WN; group 3, WN to MN; and group 4, MN to MN. Cox proportional hazard analysis was performed to clarify the association between changes in nutritional status and mortality. Being in the MN group at 12 months after dialysis initiation, but not at baseline, was a significant risk factor for mortality. There was a significant difference in the 3-year survival rates among the groups (group 1, 92.2%; group 2, 86.0%; group 3, 78.2%; and group 4, 63.5%; log-rank test, P < 0.001). Multivariate Cox regression analysis revealed that the mortality risk was significantly higher in group 3 than in group 1 (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.27-6.03, P = 0.01) whereas the mortality risk was significantly lower in group 2 compared with group 4 (HR 0.35, 95% CI 0.17-0.71, P < 0.01) even after adjustment for confounding factors. Moreover, mortality risk of group 3 was significantly higher than in group 2 (HR 2.89, 95% CI 1.22-6.81, P = 0.02); there was no significant difference between groups 1 and 2. The changes in nutritional status assessed by SGA during the first year of dialysis were associated with all-cause mortality in incident ESRD patients.
Files in This Item:
T201600508.pdf Download
DOI
10.1097/MD.0000000000002714
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kwon, Young Eun(권영은)
Kee, Youn Kyung(기연경)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yoon, Chang Yun(윤창연)
Han, Seung Gyu(한승규)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
Han, In Mee(한인미)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146436
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