Change of nutritional status assessed using subjective global assessment is associated with all-cause mortality in incident dialysis patients

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

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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 theMNgroup at 12months after dialysis initiation, but not at baseline,was a significant risk factor formortality.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.

Original languageEnglish
Pages (from-to)e2714
JournalMedicine (United States)
Volume95
Issue number7
DOIs
Publication statusPublished - 2016 Jan 1

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Nutritional Status
Dialysis
Mortality
Chronic Kidney Failure
Confidence Intervals
Cohort Studies
Survival Rate
Regression Analysis
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Kwon, Young Eun ; Kee, Youn Kyung ; Yoon, Chang Yun ; Han, In Mee ; Han, Seung Gyu ; Park, Kyoung Sook ; Lee, Mi Jung ; Park, Jung Tak ; Han, Seung H. ; Yoo, Tae Hyun ; Kim, Yong Lim ; Kim, Yon Su ; Yang, Chul Woo ; Kim, Nam Ho ; Kang, Shin Wook. / Change of nutritional status assessed using subjective global assessment is associated with all-cause mortality in incident dialysis patients. In: Medicine (United States). 2016 ; Vol. 95, No. 7. pp. e2714.
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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 theMNgroup at 12months after dialysis initiation, but not at baseline,was a significant risk factor formortality.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.",
author = "Kwon, {Young Eun} and Kee, {Youn Kyung} and Yoon, {Chang Yun} and Han, {In Mee} and Han, {Seung Gyu} and Park, {Kyoung Sook} and Lee, {Mi Jung} and Park, {Jung Tak} and Han, {Seung H.} and Yoo, {Tae Hyun} and Kim, {Yong Lim} and Kim, {Yon Su} and Yang, {Chul Woo} and Kim, {Nam Ho} and Kang, {Shin Wook}",
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Change of nutritional status assessed using subjective global assessment is associated with all-cause mortality in incident dialysis patients. / Kwon, Young Eun; Kee, Youn Kyung; Yoon, Chang Yun; Han, In Mee; Han, Seung Gyu; Park, Kyoung Sook; Lee, Mi Jung; Park, Jung Tak; Han, Seung H.; Yoo, Tae Hyun; Kim, Yong Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam Ho; Kang, Shin Wook.

In: Medicine (United States), Vol. 95, No. 7, 01.01.2016, p. e2714.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Change of nutritional status assessed using subjective global assessment is associated with all-cause mortality in incident dialysis patients

AU - Kwon, Young Eun

AU - Kee, Youn Kyung

AU - Yoon, Chang Yun

AU - Han, In Mee

AU - Han, Seung Gyu

AU - Park, Kyoung Sook

AU - Lee, Mi Jung

AU - Park, Jung Tak

AU - Han, Seung H.

AU - Yoo, Tae Hyun

AU - Kim, Yong Lim

AU - Kim, Yon Su

AU - Yang, Chul Woo

AU - Kim, Nam Ho

AU - Kang, Shin Wook

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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 theMNgroup at 12months after dialysis initiation, but not at baseline,was a significant risk factor formortality.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.

AB - 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 theMNgroup at 12months after dialysis initiation, but not at baseline,was a significant risk factor formortality.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.

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