Traditional Chinese Medicine Syndromes and Influencing Factors of Protein Energy Wasting in Chronic Kidney Disease Patients Undergoing Maintenance Hemodialysis：a Cross-sectional Study / 中医杂志

ObjectiveTo investigate the distribution of traditional Chinese medicine （TCM） syndrome types and influencing factors of protein-energy wasting （PEW） in chronic kidney disease （CKD） undergoing maintenance hemodialysis （MHD）. MethodsAccording to diagnostic criteria， 164 patients with MHD were divided into PEW group and non-PEW group. The clinical data of all patients were collected， including general information such as gender， age， height and weight， disease characteristics such as course， cormobidity， and haemodialysis duration， laboratory indicators such as blood routine， liver function， renal function， electrolyte， blood lipid， grip strength， and the four examinations. Logistic regression analysis was used to find the influencing factors of PEW by taking the clinical indicators with significant differences between the two groups （P＜0.05） as the independent variables， diagnosis of PEW as the dependent variable， and normal values as the reference. ResultsOut of 164 patients with MHD， there were 96 （58.5%） cases in PEW group and 68 cases （41.5%） in non-PEW group. Compared to the non-PEW group，PEW group had increased age， ratios of bedrest， deep vein preservation， edema， and low grip strength， percentages of comorbidities type 2 diabetes， cardiovascular and cerebrovascular diseases，infections and anemia， and levels of alanine aminotransferase and permine amin aminotransferase， as well as decreased body mass index， self-care ratio，internal arteriovenous fistula， red blood cell count， hemoglobin， serum total protein， serum albumin levels （P＜0.05）. The PEW group had significantly higher frequency of poor appetite and digestion， abdominal distension， fear of cold and preference of warmth， weak breathing and fatigue， poor appetite， oliguria， nausea and vomiting than non-PEW group （P＜0.05）. The incidence of both yin and yang deficiency syndrome and damp-turbidity syndrome were significantly higher in the PEW group than the non-PEW group， while that of liver-kidney yin deficiency syndrome and stirring of wind syndrome were lower （P＜0.05）. Logistic regression analysis showed that low BMI （＜22 kg/m2）， inability to take care of oneself， low grip strength，low serum albumin （＜38 g/L）， infection， older age， fear of cold and cold limbs，and poor appetite were the risk factors of PEW in patients undergoing MHD （P＜0.05）. ConclusionThe root syndrome of MHD-PEW patients is both yin and yang deficiency， concurrent with damp-turbidity syndrome. Low BMI， low serum albumin， infection and older age may be the influencing factors of PEW in patients undergoing MHD.

Influence of protein energy wasting on frailty in elderly patients on maintenance hemodialysis / 中华老年医学杂志

Objective:To explore the correlation between protein energy wasting(PEW)and frailty in elderly patients on maintenance hemodialysis(MHD)and influencing factors of frailty.Methods:Clinical data of patients over 60 who had received regular hemodialysis treatment at Beijing Huairou Hospital between September to December 2021 were collected.According to Fried's evaluation criteria, patients were divided into a frailty group and a non-frailty group, and differences between the two groups were compared.Spearman correlation analysis was conducted to assess the correlation between protein energy wasting and frailty.Logistic regression was used to analyze the influencing factors of frailty in elderly patients on MHD.Results:A total of 81 MHD patients enrolled in this study, with 36 in the frailty group.The frailty group was older, had a higher proportion of patients with PEW, and underwent more months of dialysis, with a higher proportion of patients with diabetic nephropathy as the primary disease, having high levels of C-reactive protein(CRP), and having low KT/V, hemoglobin, albumin, body mass index(BMI), mid-arm circumference(MAC)and mid-arm muscle circumference(MAMC), and the differences with the control group were statistically significant(all P<0.05). The Fried frailty phenotype was positively correlated with age( r=0.021, P=0.047), but negatively associated with HGB( r=-0.329, P=0.003), albumin( r=0.021, P=0.047), BMI( r=0.021, P=0.047), TSF( r=-0.274, P=0.013), MAC( r=-0.554, P<0.001)and MAMC( r=-0.293, P=0.008). A Logistic regression equation was constructed using frailty as the dependent variable.The results showed that age, months of dialysis, KT/V, serum albumin and CRP were independent factors influencing the development of frailty in elderly patients with MHD. Conclusions:PEW and frailty coexist and interact with each other in elderly patients with MHD.Clinicians should place emphasis on the assessment of frailty and protein energy wasting in elderly dialysis patients and achieve early detection and intervention to avoid adverse clinical outcomes.

Effect of Modified Shenling Baizhusan on Gastrointestinal Dysfunction and Protein-energy Wasting in Continuous Ambulatory Peritoneal Dialysis Patients / 中国实验方剂学杂志

ObjectiveTo observe and analyze the effect of modified Shenling Baizhusan on gastrointestinal dysfunction and protein-energy wasting （PEW） of continuous ambulatory peritoneal dialysis （CAPD） patients with the syndrome of spleen deficiency， blood stasis， and dampness. MethodA total of 66 CAPD patients with the above syndrome were randomized into the observation group and control group， 33 cases in each group. However， 3 cases in each group dropped out， finally leaving 30 cases in each group. Both groups received CAPD and conventional symptomatic treatment. On this basis， the observation group was given modified Shenling Baizhusan （1 bag/day， once in the morning and again in the evening， 12 weeks）， and the control group the bifidobacterium capsules （1.05 g/time， twice/day， 12 weeks）. Before and after treatment， the traditional Chinese medicine （TCM） syndrome score， gastrointestinal symptom rating scale （GSRS） score， and malnutrition-inflammation score （MIS） in two groups were recorded， and the levels of serum albumin （ALB）， prealbumin （PA）， transferrin （TRF）， gastrin-17 （G-17）， tumor necrosis factor alpha （TNF-α）， interferon-γ （IFN-γ）， and interleukin-10 （IL-10） were detected. Moreover， body mass index （BMI） was calculated. ResultAfter treatment， the alleviation of the TCM syndrome in the observation group was better than that in the control group （Z=-2.591， P<0.05）， and the TCM syndrome score in the observation group was lower than that in the control （P<0.05）. The symptom scores， MIS， and G-17 of the observation group were significantly decreased compared with those before observation and in the control group （P<0.05）. After treatment， the GSRS scores of the two groups were significantly lower than those before treatment （P<0.05）， particularly the observation group （P<0.05）. ALB， PA， TRF， and BMI of the observation group after treatment were increased compared with those before treatment and those of the control group after treatment （P<0.05）. After treatment， serum TNF-α and IFN-γ of the two groups were significantly reduced compared with those before treatment （P<0.05）， and the levels of the two in the observation group were significantly lower in the observation group than in the control group （P<0.05）. After treatment， IL-10 level of the observation group was higher than that before treatment and in the control group （P<0.05）. ConclusionThe modified Shenling Baizhusan can relieve the gastrointestinal dysfunction and PEW in CAPD patients with the syndrome of spleen deficiency， blood stasis， and dampness.

Influencing factors of protein energy wasting in maintenance hemodialysis patients / 国际生物医学工程杂志

Objective:To explore the main risk factors of protein energy expenditure (PEW) in maintenance hemodialysis (MHD) patients.Methods:According to diagnostic criteria, 166 patients with MHD were divided into PEW group and control group. The general clinical data, physical indexes, and physical and chemical analysis results of all patients was collected, and the differences in indexes between the two groups of patients were compared. Logistic analysis was used to find the risk factors of MHD combined with PEW.Results:There were statistically significant differences in blood pressure, protein intake, vitamin intake, and uric acid, creatinine, blood calcium levels between the PEW group and the control group (all P<0.05). Multivariate logistic regression analysis showed that blood pressure, daily sleep time, whether to take vitamins, body mass index (BMI), creatinine and parathyroid hormone (PTH) were the risk factors of MHD combined with PEW. Conclusions:In clinical practice, more attention should be paid to controlling blood pressure, improving sleep, and supplementing vitamins in patients with MHD.

Study on the Improvement Effects of Sijunzi Decoction on Chronic Kidney Disease-protein Energy Wasting Model Mice and Its Mecranism / 中国药房

OBJECTIVE：To study the improvement effects of Sijunzi decoction on skeletal muscle atrophy in chronic kidney disease-protein energy wasting （CKD-PEW）model mice ，and to explore its potential mechanism . METHODS ：A total of 80 mice were randomly divided into sham operation group （n＝10）and modeling group （n＝70）. CKD-PEW model was established by removing 5/6 kidneys and giving a low-protein diet （4％ casein）for mice in modeling group. Totally 50 modeled mice were randomly divided into model group ，Sijunzi decoction low-dose ，medium-dose and high-dose groups [ 2.34，4.68，9.36 g/（kg·d）， by crude drug] ，Compound α-ketoacid tablets group [positive control ，1 g/（kg·d）]，with 10 mice in each group. Administration groups were given relevant medicine intragastrically ；sham operation group and model group were given constant volume of normal saline intragastrically ，once a day ，for consecutive 14 d. After last medication ，body weight of mice and wet mass of left tibialis anterior muscle （TA）were weighed ；TA cross-sectional area was determined ；protein synthesis and decomposition metabolism ability of TA were detected ；mRNA expressions of Bcl-2，Bax and Caspase-3 in TA were detected by Real-time PCR ；protein expressions of muscular dystrophin Fbox- 1 （Atrogin-1），myofloin-1 （MuRF-1），Rho-related protein kinase 1 （ROCK1）， phosphorylated PTEN （p-PTEN），phosphatidylinositol-3-kinase（PI3K）and phosphorylated Akt （p-Akt）in TA were detected by Western blotting. RESULTS ：Compared with the sham operation group ，the body weight ，TA wet weight ，protein synthesis metabolism ability of TA as well as protein expressions of PI 3K and p-Akt were decreased significantly in model group （P＜0.05）； the cross-sectional area of TA decreased significantly （P＜0.05）；protein decomposition metabolism ability of TA ，Bax/Bcl-2 ratio， Caspase-3 mRNA expression ，protein expressions of Atrogin- 1，MuRF-1，ROCK1 and p-PTEN were increased significantly （P＜ 0.05）. Compared with model group ，above indexes of mice were all improved significantly in Sijunzi decoction medium-dose ， high-dose groups and Compound α-ketoacid tablets group （P＜0.05）. CONCLUSIONS ：Sijunzi decoction can increase the body weight of CKD-PEW model mice and alleviate the skeletal atrophy ；the mechanism may be related to regulating ROCK 1/PTEN/Akt signaling pathway activity ，inhibiting the expression of Atrogin- 1 and MuRF- 1.

Combating protein energy wasting in end stage kidney disease: role of exogenous proteolytic enzyme as an adjuvant to dietary protein

Background: Despite interventions, the prevalence of protein energy wasting in patients on dialysis continues to be unacceptably high. The objective of the study is to evaluate the efficacy of exogenous proteolytic enzyme Aminace 70000 (Hemoglobin Tyrosine Unit), as an adjuvant to dietary protein in improving the nutritional status.Methods: This is a retrospective, real world, single centre, observational study, aimed at assessing the changes in key nutritional indices, over 6 months in patients with chronic kidney disease (CKD) initiated on continuous ambulatory peritoneal dialysis (CAPD). The intervention included addition of egg protein and use of an exogenous proteolytic enzyme. Three cohorts were identified. Cohort 1, had access to a nephrologist and CAPD counsellor; Cohort 2, in addition had access to a dietician who emphasized the need for increase in dietary protein in form of 4-6 eggs a day; and cohort 3, were in addition given an exogenous proteolytic enzyme with the major protein meal.Results: The absolute fall in serum albumin at 6 months for the cohort 1, 2 and 3 is 0.48, 0.29 and 0.09 gm/dl respectively. Not only was the fall in serum albumin significantly less with the use of exogenous proteolytic enzyme, a higher proportion of patients were able to maintain or improve their serum albumin. The fall in midarm circumference was maximum in cohort 1 (2.08 cm) and least in cohort 3 (0.45 cm). This positive trend however, did not achieve statistical significance.Conclusions: Use of exogenous proteolytic enzyme, when combined with egg protein, improves key nutritional indices in patients of CKD on CAPD.

Study on the correlation between red blood cell volume distribution width and protein energy wasting in maintenance hemodialysis patients / 中国实用内科杂志

OBJECTIVE: To study the relationship between red blood cell volume distribution width(RDW)and protein energy wasting(PEW)in maintenance hemodialysis(MHD)patients. METHODS: A multicenter cross-sectional study was conducted in eight hemodialysis centers of Guizhou province in 2018.Clinical data,laboratory values,physical parameters and body composition data of MHD patients were collected. According to the quartile of RDW,the patients were divided into four groups. The differences in the indexes among the 4 groups were compared.Logistic regression models were used to analyze the relationships between RDW and the occurance of PEW. The receiver operating characteristic curves(ROC)was applied to evaluate the predictive power of RDW for PEW. RESULTS: Totally 594 MHD patients were enrolled and were divided into 4 groups,value according to RDW quartile(Q1,Q2,Q3 and Q4). Logistic regression analysis showed that the occurance of PEW was correlated with RDW in MHD patients. The risk of PEW in MHD Q4 group was 2.583 times higher than that of the Q1 group(95%CI 1.588-4.202, P<0.001). After adjustment for patients' age, gender, DM history,dialysis age,hemoglobin, serum phosphorus, serum alanine aminotransferase and aspartate aminotransferase,the risk of Q4 group was 2.197 fold higher than that of Q1 group(95%CI 1.306-3.698, P<0.005). Recover operating characteristic(ROC)analysis showed that the optimal threshold for predicting PEW risks in MHD patients was 15.6% with a sensitivity and specificity of 40.35% and78.72% respectively and the area under curve was 0.611(95%CI 0.570-0.650,P<0.0001). CONCLUSION:s For MHD patients,RDW is associated with the occurance of PEW and has the value for PEW.

Protein-energy wasting syndrome in diabetic nephropathy: diagnosis and treatment / 中国实用内科杂志

Protein-energy wasting(PEW)is common in patients with diabetic nephropathy. PEW is closely associated with decreased life quality and results in increased rates of death in chronic kidney disease patients. In clinical settings, doctors should pay attention to the screening and diagnosis of PEW,and make judgment from the following four aspects: biochemical indexes, weight loss, a decrease in muscle mass, and low protein and/or energy intakes. Prevention and treatment of PEW involve Individualized optimal nutritional support, physical exercise, follow-up and regular surveillance.

Relationship between protein-energy wasting and mineral metabolism disorders in maintenance hemodialysis patients / 中国实用内科杂志

Protein-energy wasting(PEW)and chronic kidney disease-mineral and bone disorder(CKD-MBD)are common complications in maintenance hemodialysis(MHD)patients, and they have notable correlation with the mortality of MHD patients. PEW and CKD-MBD have a common pathophysiological basis and are mutually reinforcing factors. At the same time, their therapy strategies also affect each other. Uremia status, hemodialysis treatment, chronic inflammatory, metabolic acidosis, nutrient intake and musculoskeletal pain promote the development of PEW and MBD. Improvement in the hemodialysis quality, keeping balanced diet of protein and phosphorus intake, and scientific rational physical exercise may improve both PEW and MBD, thereby reducing mortality and improving life quality in MHD patients.

A multi-center clinical study on the relationship between dry weight and protein energy wasting in patients with maintenance hemodialysis / 中国实用内科杂志

OBJECTIVE: To explore the relationship between dry weight setting and the related parameters of PEW of multicenter hemodialysis patients in Guizhou. in order to provide the basis for setting dry weight in patients. METHODS: We conducted the research in patients of 11 hemodialysis center in Guizhou province. We collected demographic data(age, gender, nationality, marital status, education level, income status and so on) by questionnaire; are collected dry weight, ECW, ICW, fat mass,lean body mass and so on by bioelectrical impedance analysis, and then we also collected physical measurement indexes, such as waist circumference, hip circumference, medium arm circumference(MAC), tricep fold thickness(TSF)and crus diameter. The data is divided into three groups according to the dry weight setings. Group 1: dry weight setting was slightly lower(dry weight setted by doctors was slightly lower than bioelectrical impedance analysis results,withen 1 kg); group 2: dry weight setting was normal; group 3: dry weight setting slightly higher group(dry weight setted by doctors was slightly higher than bioelectrical impedance analysis results,withen 1 kg). We used Chi-square analysis to analyze PEW prevalence, compared differences of the PEW indications by variance analysis, and then we used Spearman correlation analysis to analyze the correlation between PEW and the indications. Influence of various factors on the PEW was analyzed by logistic regression analysis. RESULTS: The PEW morbidity of group 3 was higher than the other two groups. PEW indicators such as upper arm midpoint diameter, tricep fold thickness, hip circumference, fat mass, BMI, Hb, Alb and prealbumin were lower than the other two groups, the difference being statistically significant(P<0.05). Correlation analysis results show that the degree of the factors associated with the PEW was as follows in turn BMI(r=-0.677, P<0.05), dry weight(r=0.636, P<0.05), upper arm midpoint diameter(r=-0.589, P<0.05), albumin(r=-0.562, P<0.05) and hip circumference(r=-0.475, P<0.05). Logistic regression showed that the factors affecting PEW were albumin(OR = 0.883, 95%CI: 0.782-0.997, P<0.05), BMI(OR = 0.671, 95%CI: 0.509-0.884, P<0.05), upper arm midpoint diameter(OR = 0.457, 95% CI: 0.318-0.655, P<0.05) and dry weight(OR = 1.191, 95%CI: 1.041-1.363, P<0.05). CONCLUSION: The dry weight setting too high, insufficient amount of ultrafiltration and inadequate dialysis can increase the occurrence of PEW.

The role of probiotic on protein energy wasting and micro-inflammation in peritoneal dialysis patients / 中国实用内科杂志

OBJECTIVE: To investigate the effect of probiotic on protein energy wasting and micro-inflammation in peritoneal dialysis patients. METHODS: One hundred and twelve patients who underwent peritoneal dialysis at the nephrology department of Guizhou provincial people's hospital in 2017, were randomly divided into intervention group(n=56) and control group(n=56), which were treated probiotic and placebo respectively two months, and collected biochemical, inflammatory, physical measurement and bioelectrical impedance index before and after treatment. RESULTS: The prevalence of protein-energy wasting was 64.29% and 60.71%in intervention group and control group, respectively. Compared with control group, patients in intervention group had lower urea nitrogen, triglyceride, low density lipoprotein, high-sensitivity C-reactive protein and interleukin-6 and higher serum albumin levels, and these differences were statistically significant(P<0.05). Physical measurement results showed that the upper arm muscle circumference of intervention group was increased compared to control group, and the change was statistically significant(P<0.05). Biological resistance testing results showed that the fat percentage of intervention group was significantly higher than that of control group(P<0.05).CONCLUSION: The treatment of probiotic could improve protein energy wasting and micro-inflammation in continuous peritoneal dialysis patients.

A review of nutritional screening and assessment tools for protein-energy wasting in maintenancehemodialysis patients / 医学研究生学报

Most of the maintenance hemodialysis patients (MHD) have a risk of protein energy waste (PEW). PEW is not only an independent risk factor for death，but also closely related to poor prognosis and quality of life in patients with MHD. At present, the mechanism of PEW is still unknown, so there are many ways to screen and assess it. This paper reviews the commonly used evaluation tools and their respective advantages and disadvantages through single and multiple factors.

Muscle mass evaluation and influential factors of sarcopenia in maintenance hemodialysis patients / 中华肾脏病杂志

Objective To evaluate the muscle mass in maintenance hemodialysis (MHD) patients and analyze the influential factors.Methods Ninety-seven patients on MHD and 34 healthy people were recruited.Muscle mass was measured by bioelectrical impedance analysis and compared.Patients'age,sex,height,body weight,walking activity,modified quantitative subjective global assessment (MQSGA) score and laboratory tests were recorded.The relationship of appendicular skeletal muscle mass/height2 (ASM/H2) and other factors were analyzed using multivariate linear regression.Results Compared with normal cohort,the MHD patients showed lower body fat rate and lower ASM/H2 (both P ＜ 0.05).In 97 MHD patients,21.4％ of male patients suffered from sarcopenia,and 24.4％ of female patients suffered from sarcopenia.Patients were divided into two groups according to the level of ASM/H2 (male ＜ 7.0 kg/m2,female ＜ 5.8 kg/m2).The grip strength,serum creatinine,1,25(OH)2D and mid-arm muscle circumference in low ASM/H2 group were lower than those in normal ASM/H2 group,and the differences were significant (all P ＜ 0.05).In multivariable regression model,male (β=0.534,P=0.003),1,25(OH)2D (β=0.582,P=0.024),creatinine (β=0.421,P=0.037),grip strength (β=0.681,P=0.001),and lg[NT-proBNP] (β=-1.760,P=0.042) were independently associated with ASM/H2 in MHD patients.Conclusion The prevalence of sarcopenia is much higher in MHD patients than in healthy people.The levels of grip strength,NT-proBNP,creatinine and 1,25(OH)2D are the important influential factors for muscle mass in MHD patients.

Nutritional Status in Adults with Predialysis Chronic Kidney Disease: KNOW-CKD Study

Adverse changes in nutrition are prevalent and are strong indicators of adverse outcomes in patients with chronic kidney disease (CKD). The International Society of Renal Nutrition and Metabolism (ISRNM) proposed a common nomenclature and diagnostic criteria to identify protein-energy wasting (PEW) in CKD patients. We examined the nutritional status in 1,834 adults with predialysis CKD enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD) study. As there was a need for further understanding of nutritional status and associated factors in CKD, we evaluated the prevalence and associated factors of PEW in adults with predialysis CKD. The prevalence of PEW was about 9.0% according to ISRNM criteria and tended to increase with advanced stage in predialysis CKD. Those who concurrently had PEW, inflammation, and CVD were a small proportion (0.4%). In multivariate logistic regression model, PEW was independently associated with estimated glomerular filtration rate (eGFR) (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96–0.99), total CO2 (OR, 0.93; 95% CI, 0.87–0.99), physical activity (OR, 0.43; 95% CI, 0.26–0.69), comorbid diabetes (OR, 1.68; 95% CI, 1.09–2.59), and high sensitivity C-reactive protein (hs-CRP) (OR, 1.03; 95% CI, 1.01–1.06). Our study suggests that PEW increases with advanced CKD stage. PEW is independently associated with renal function, low total CO2, low physical activity, comorbid diabetes, and increased hs-CRP in adults with predialysis CKD.

Changes in geriatric nutritional risk index and risk of major adverse cardiac and cerebrovascular events in incident peritoneal dialysis patients

BACKGROUND: Geriatric nutritional risk index (GNRI) is a validated nutritional assessment method, and lower GNRI values are closely associated with adverse clinical outcomes in dialysis patients. This study investigated the impact of changes in GNRI during the first year of dialysis on cardiovascular outcomes in incident peritoneal dialysis (PD) patients. METHODS: We reviewed medical records in 133 incident PD patients to determine GNRI at the start of PD and after 12 months. Patients were categorized into improved (delta GNRI > 0) and worsening/stationary (delta GNRI ≤ 0) groups. The primary outcome was major adverse cardiac and cerebrovascular events (MACCEs). RESULTS: During a mean follow-up of 51.1 months, the primary outcome was observed in 42 patients (31.6%). The baseline GNRI at PD initiation was not significantly associated with MACCEs (log-rank test, P = 0.40). However, the cumulative event-free rate was significantly lower in the worsening or stationary GNRI group than in the improved group (log-rank test, P = 0.004). Multivariate Cox analysis revealed that a worsening or stationary GNRI was independently associated with higher risk for MACCEs (hazard ratio, 2.47; 95% confidence interval, 1.15–5.29; P = 0.02). In subgroup analysis, patients with worsening or stationary GNRI were at significantly greater risk for MACCEs in both the lower (P = 0.04) and higher (P = 0.01) baseline GNRI groups. CONCLUSION: Baseline GNRI was not associated with MACCEs, but patients with deteriorating or stationary nutritional status were at significantly greater risk for MACCEs, suggesting that serial monitoring of nutritional status is important to stratify cardiovascular risk in incident PD patients.

Comparison of three nutritional screening tools for assessment of dialysis-related protein-energy wasting in maintenance hemodialysis patients / 肠外与肠内营养

Objective:To compare three nutritional screening tools in predicting dialysis-related pro tein-energy wasting(PEW) among maintenance hemodialysis(MHD) patients and to find a more rapid,accurate,and feasible screening tool.Methods:The nutrtional risk screening 62002 (NRS 2002),7-point subjective global assessment(SGA) and malnutrition inflammation scores (MIS) were compared among 205 MHD patients.Correlations between the serum biochemistry,anthropometry and different screening tools were analyzed,and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW.Results:A total of 31.2％ of HD patients had PEW by ISRNM criteria,whilst using NRS 2002,7-point SGA and MIS,58％,40.8％ and 46.8％ of MHD patients exhibited PEW respectively.The results of three screening tools were closely related to those by serum biochemistry and anthropometry (P ＜ 0.05),but the composite correlation coefficient between the screening tools for PEW and the objective nutritional index commonly used was higher in NRS 2002(r =0.787,P ＜ 0.001) than in 7-Point SGA or MIS.NRS 2002 had higher sensitivity and accuracy values (87.5％ and 59.1％,respectively) in MHD Patients.Conclusion:MIS,7-PointSGA and NRS 2002 are valid tools for nutrition screening of dialysis patients,and NRS 2002 may be the best one.

The use of bioelectrical impedance phase angle for predicting protein-energy wasting in hemodialysis patients / 中华临床营养杂志

Objective To evaluate the use of bioelectrical impedance phase angle (PhA) for predicting protein-energy wasting (PEW) in hemodialysis patients.Methods This cross-sectional study involved 144 patients who were on maintenance hemodialysis (MHD) in the blood purification centers of two tertiary hospitals in Guangzhou,where the body impedance analysis (BIA) was performed after the hemodialysis procedure and the prevalence of protein-energy wasting (PEW) was investigated by the 7-point subjective global assessment (SGA) among.Nutritional indices of the patients with PEW were compared with the well-nourished patients to identify independent variables that can predict PEW and determine the cut-off value of PhA as a predictor.Results The patients with PEW had significantly lower PhA values than the Non-PEWpatients (t =8.68,P=0.00).PhA was positively related with the nutritional indices reflecting function of body proteins or muscles,such as serum albumin (rs=0.25,P=0.00),prealbumin (rs=0.31,P=0.00),free fat mass index (rs=0.25,P=0.00),and mid-arm muscle circumference (rs =O.44,P =O.00).However,the correlations of PhA with fat mass (rs =0.04,P=0.66) and body fat percentage (rs =-0.04,P=0.66) were no statistical significance.Multivariate logistic regression analysis revealed that PhA (OR =4.48,P =0.00) and body mass index (OR =1.59,P =0.00) were independent predictors of PEW,but PhA was more potent than BMI.Receiver operating characteristic curve analysis suggested that the optimum PhA cut-off point for predicting PEW was 4.6.Conclusion PhA can be a useful independent predictor for PEW in hemodialysis patients and its cut-off value is 4.6.

Advances in Traditional Chinese Medicine Research on Protein-energy Wasting of Chronic Kidney Disease / 浙江中医药大学学报

[Objective]To summarize the advances in traditional Chinese medicine research on protein-energy wasting(PEW) of chronic kidney disease(CKD).[Methods]Read the domestic and foreign literature about PEW in recent years.Collate,study and summarize etiology and pathogenesis,therapeutic principle and symptomatology of PEW,as well as the application of classical prescriptions,compound prescriptions,single herbs and traditional Chinese external treatments about PEW.[Results]The external cause of PEW is feelings of six vessel disease,and the internal cause is weak and damage of Zang and Fu viscera.The pathogenesis consists of deficiency of Ben and repletion of Biao.Deficiency of Ben means dysfunction of Zang and Fu viscera,lack of Qi and blood,Yin and Yang.The disease mainly locates in the spleen and kidney;the retention of damp and hot,phlegm turbidity,blood stasis and water poison,damages the renal collaterals,which constitute Biao of PEW.The chief principle of treatment is to support the right and expel the evil.Emphasis on dialectical therapy,and center on "nourishing kidney and strengthening spleen,benefiting qi and nourishing blood,activating blood and removing stasis,cleaning bowel and dispelling turbidity,detoxificating and reconciling collaterals".Deficiency and excess exist simultaneously in the symptomatology of PEW.Qi deficiency of spleen and kidney is the most common deficiency syndrome,damp and turbidity,damp and hot and blood stasis are seen most of the time in accompanied symptom.Classical prescriptions,single traditional Chinese herb,and external therapy of TCM will be uesd to create good application prospect in the TCM treatments of PEW,which effectively improve clinical symptoms,increase nutrition related indicators,reduce micro-inflammatory response,and finally raise living quality of patients.[Conclusion]Traditional Chinese medicine treatments of the PEW provide advantages and have made certain achievements,which are worth further studying.

A comparative study of protein energy wasting patients on maintenance hemodialysis with or without diabetic kidney disease / 国际生物医学工程杂志

Objective To analyze the differences of nutritional parameters and body composition in the protein energy wasting (PEW) patients on maintenance hemodialysis with or without diabetic kidney disease (DKD).Methods The patients with PEW were screened by subjective global assessment (SGA) from patients on maintenance hemodialysis from March 2014 to June 2015 in the Fourth Central Hospital of Tianjin.Anthropometric and nutritional parameters were collected before dialysis, and body composition and energy expenditure were examined by the bioelectrica] impedance method.The indexes of the two groups were compared.Results A total of 301 patients on maintenance hemodialysis (DKD 112, non-DKD 189), whose average age was (63.05±14.42) years old, were screened.Among which, 75 patients were diagnosed with PEW, and the overall prevalence rate was 24.92％, including 41 DKD cases with the prevalence of 36.61％ (41/112) and 34 non-DKD cases with the prevalence of 17.99％ (34/189).Compared with uon-PEW patients, the body mass index (BMI), hemoglobin (Hb), albumin (ALB), and total cholestero (TC) of patients with PEW were significantly lower, and C-reactive protein (CRP) were significantly higher (P＜0.05).In the DKD group, the average age of PEW onset ((59.61±13.74) years old), the maintenance dialysis time before PEW ((64± 12.50) months), ALB ((31.34±3.32) g/L), and TC ((4.17±0.95) mol/L) were all lower than those in the non-DKD group ((70.68±14.05) years old, (116.61 ±32.85) months, (32.34±4.64) g/L, (4.95±1.52) mol/L) (P＜ 0.05), respectively.The body composition results showed that muscle mass in the DKD group ((24.84±3.36) kg/ (45.32±6.95)％) was less than that of the non-DKD group ((28.53±3.75) kg/(50.67±7.28)％) (P＜0.05).Conclusions This study indicates that compared with non-DKD dialysis patients, the prevalence of PEW in dialysis patients with DKD is higher, onset age of PEW is younger, the duration of dialysis is shorter, and the muscle consumption is more obvious.

Progress of diagnosis and treatment for protein-energy wasting in children with chronic kidney disease / 中华实用儿科临床杂志

Protein-energy wasting is a common complication in patients with chronic kidney disease and also an independent risk factor for poor prognosis.The progress of diagnosis and treatment for protein-energy wasting in children with chronic kidney disease were summarized.