Affiliations 

  • 1 Department of Medical Epidemiology and Biostatistics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden. Electronic address: juan.jesus.carrero@ki.se
  • 2 Division of Biostatistics (FT), Department of Preventive Medicine, and Division of Nephrology, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
  • 3 Department of Transplantation and Surgery, Semmelweis University, Budapest
  • 4 Obafemi Awolowo University, Nigeria
  • 5 Department of Medical Epidemiology and Biostatistics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden; Nutrition Institute, Rio de Janeiro State University, Brazil
  • 6 Department of Nutrition and Dietetics, The St. George Hospital, Kogarah, Australia
  • 7 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Poland
  • 8 Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
  • 9 Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
  • 10 Division of Nephrology, Department of Medicine and Surgery, University of Parma, Parma, Italy
  • 11 Department of Nephrology, Dialysis, Hypertension, Hôpital Edouard Herriot, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
  • 12 Division of Nephrology, University of Ulsan College of Medicine, Ulsan, Republic of Korea
  • 13 Department of Medicine, Division of Nephrology and Hypertension and Vanderbilt Center for Kidney Diseases Vanderbilt University Medical Center, Nashville, TN; Veterans Administration Tennessee Valley Healthcare System, Nashville, TN
  • 14 Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, UK
  • 15 Division of Nephrology and Hypertension, University of California, Irvine, School of Medicine, Orange, California
  • 16 School of Biosciences, Faculty of Health & Medical Science, Taylor's University Lakeside Campus, Malaysia
  • 17 Department of Medical Epidemiology and Biostatistics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden
  • 18 Sjællands University Hospital, Roskilde, Denmark
  • 19 Graduate Program in Medical Sciences and Graduate Program in Cardiovascular Sciences, Fluminense Federal University, Niterói-RJ, Brazil
  • 20 Division of Nephrology, Departments of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Canada
  • 21 Case Western Reserve University Department of Nutrition, Cleveland, Ohio
  • 22 Department of Nephrology, Sanjay Gandhi Post Graduate, Institute of Medical Sciences, Lucknow, India
  • 23 Baskent University Faculty of Medicine, Ankara, Turkey
  • 24 Service of Nephrology, Hospital of Sion, University of Lausanne, Switzerland
  • 25 Department of Nephrology VUmc, ICaR-VU, Amsterdam
  • 26 Johannesburg, Gauteng, South Africa
  • 27 Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
J Ren Nutr, 2018 11;28(6):380-392.
PMID: 30348259 DOI: 10.1053/j.jrn.2018.08.006

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) 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.