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) non-dialyzed 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. (C) 2018 by the National Kidney Foundation, Inc. All rights reserved.

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 / Carrero, J. J.; Thomas, F.; Nagy, K.; Arogundade, F.; Avesani, C. M.; Chan, M.; Chmielewski, M.; Cordeiro, A. C.; Espinosa-Cuevas, A.; Fiaccadori, E.; Guebre-Egziabher, F.; Hand, R. K.; Hung, A. M.; Ikizler, T. A.; Johansson, L. R.; Kalantar-Zadeh, K.; Karupaiah, T.; Lindholm, B.; Marckmann, P.; Mafra, D.; Parekh, R. S.; Park, J.; Russo, S.; Saxena, A.; Sezer, S.; Teta, D.; Ter Wee, P. M.; Verseput, C.; Wang, A. Y. M.; Xu, H.; Lu, Y.; Molnar, M. Z.; Kovesdy, C. P.. - In: JOURNAL OF RENAL NUTRITION. - ISSN 1051-2276. - 28:6(2018), pp. 380-392. [10.1053/j.jrn.2018.08.006]

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

Thomas F.;Fiaccadori E.;Russo S.;
2018-01-01

Abstract

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) non-dialyzed 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. (C) 2018 by the National Kidney Foundation, Inc. All rights reserved.
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 / Carrero, J. J.; Thomas, F.; Nagy, K.; Arogundade, F.; Avesani, C. M.; Chan, M.; Chmielewski, M.; Cordeiro, A. C.; Espinosa-Cuevas, A.; Fiaccadori, E.; Guebre-Egziabher, F.; Hand, R. K.; Hung, A. M.; Ikizler, T. A.; Johansson, L. R.; Kalantar-Zadeh, K.; Karupaiah, T.; Lindholm, B.; Marckmann, P.; Mafra, D.; Parekh, R. S.; Park, J.; Russo, S.; Saxena, A.; Sezer, S.; Teta, D.; Ter Wee, P. M.; Verseput, C.; Wang, A. Y. M.; Xu, H.; Lu, Y.; Molnar, M. Z.; Kovesdy, C. P.. - In: JOURNAL OF RENAL NUTRITION. - ISSN 1051-2276. - 28:6(2018), pp. 380-392. [10.1053/j.jrn.2018.08.006]
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