Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients

Renée de Mutsert, Diana C. Grootendorst, Elisabeth W. Boeschoten, Hans Brandts, Jeanette Gabrielle van Manen, Raymond T. Krediet, Friedo W. Dekker

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: The subjective global assessment of nutritional status (SGA) is used to assess the nutritional status of chronic dialysis patients, but longitudinal data in relation to mortality risk are lacking. - Objective: Our objective was to study the long-term and time-dependent associations of the SGA with mortality risk in chronic dialysis patients. - Design: In a prospective, longitudinal, observational, multicenter study of incident dialysis patients, the 7-point SGA [7 = normal nutritional status; 1 = severe protein-energy wasting (PEW)] was assessed 3 and 6 mo after the start of dialysis and subsequently every 6 mo during 7 y of follow-up. With Cox regression analysis, we calculated hazard ratios (HRs) of the baseline and time-dependent SGA measurements, adjusted for age, sex, treatment modality, primary kidney diseases, and comorbidity. - Results: In total, 1601 patients were included [mean (±SD) age: 59 ± 15 y; 61% men; 23% with moderate PEW (SGA4–5), and 5% with severe PEW (SGA1–3)]. There was a dose-dependent trend of the 7-point SGA with mortality. Compared with a normal nutritional status at baseline, SGA4–5 (HR: 1.6; 95% CI: 1.3, 1.9) and SGA1–3 (HR: 2.1; 95% CI: 1.5, 2.8) were associated with an increase in 7-y mortality. Time-dependently, these associations were stronger: SGA4–5 (HR: 2.1; 95% CI: 1.7, 2.5) and SGA1–3 (HR: 5.0; 95% CI: 3.8, 6.5). - Conclusions: In dialysis patients, PEW at baseline assessed with SGA was associated with a 2-fold increased mortality risk in 7 y of follow-up. Time-dependently, this association was even stronger, which indicated that PEW was associated with a remarkably high risk of short-term mortality. These data imply that the 7-point SGA may validly distinguish different degrees of PEW associated with increasing risks of mortality.
Original languageUndefined
Pages (from-to)787-793
JournalAmerican journal of clinical nutrition
Volume89
Issue number3
DOIs
Publication statusPublished - 2009

Keywords

  • IR-76910
  • METIS-261025

Cite this

de Mutsert, Renée ; Grootendorst, Diana C. ; Boeschoten, Elisabeth W. ; Brandts, Hans ; van Manen, Jeanette Gabrielle ; Krediet, Raymond T. ; Dekker, Friedo W. / Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients. In: American journal of clinical nutrition. 2009 ; Vol. 89, No. 3. pp. 787-793.
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title = "Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients",
abstract = "Background: The subjective global assessment of nutritional status (SGA) is used to assess the nutritional status of chronic dialysis patients, but longitudinal data in relation to mortality risk are lacking. - Objective: Our objective was to study the long-term and time-dependent associations of the SGA with mortality risk in chronic dialysis patients. - Design: In a prospective, longitudinal, observational, multicenter study of incident dialysis patients, the 7-point SGA [7 = normal nutritional status; 1 = severe protein-energy wasting (PEW)] was assessed 3 and 6 mo after the start of dialysis and subsequently every 6 mo during 7 y of follow-up. With Cox regression analysis, we calculated hazard ratios (HRs) of the baseline and time-dependent SGA measurements, adjusted for age, sex, treatment modality, primary kidney diseases, and comorbidity. - Results: In total, 1601 patients were included [mean (±SD) age: 59 ± 15 y; 61{\%} men; 23{\%} with moderate PEW (SGA4–5), and 5{\%} with severe PEW (SGA1–3)]. There was a dose-dependent trend of the 7-point SGA with mortality. Compared with a normal nutritional status at baseline, SGA4–5 (HR: 1.6; 95{\%} CI: 1.3, 1.9) and SGA1–3 (HR: 2.1; 95{\%} CI: 1.5, 2.8) were associated with an increase in 7-y mortality. Time-dependently, these associations were stronger: SGA4–5 (HR: 2.1; 95{\%} CI: 1.7, 2.5) and SGA1–3 (HR: 5.0; 95{\%} CI: 3.8, 6.5). - Conclusions: In dialysis patients, PEW at baseline assessed with SGA was associated with a 2-fold increased mortality risk in 7 y of follow-up. Time-dependently, this association was even stronger, which indicated that PEW was associated with a remarkably high risk of short-term mortality. These data imply that the 7-point SGA may validly distinguish different degrees of PEW associated with increasing risks of mortality.",
keywords = "IR-76910, METIS-261025",
author = "{de Mutsert}, Ren{\'e}e and Grootendorst, {Diana C.} and Boeschoten, {Elisabeth W.} and Hans Brandts and {van Manen}, {Jeanette Gabrielle} and Krediet, {Raymond T.} and Dekker, {Friedo W.}",
year = "2009",
doi = "10.3945/​ajcn.2008.26970",
language = "Undefined",
volume = "89",
pages = "787--793",
journal = "American journal of clinical nutrition",
issn = "0002-9165",
publisher = "American Society for Nutrition",
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Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients. / de Mutsert, Renée; Grootendorst, Diana C.; Boeschoten, Elisabeth W.; Brandts, Hans; van Manen, Jeanette Gabrielle; Krediet, Raymond T.; Dekker, Friedo W.

In: American journal of clinical nutrition, Vol. 89, No. 3, 2009, p. 787-793.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients

AU - de Mutsert, Renée

AU - Grootendorst, Diana C.

AU - Boeschoten, Elisabeth W.

AU - Brandts, Hans

AU - van Manen, Jeanette Gabrielle

AU - Krediet, Raymond T.

AU - Dekker, Friedo W.

PY - 2009

Y1 - 2009

N2 - Background: The subjective global assessment of nutritional status (SGA) is used to assess the nutritional status of chronic dialysis patients, but longitudinal data in relation to mortality risk are lacking. - Objective: Our objective was to study the long-term and time-dependent associations of the SGA with mortality risk in chronic dialysis patients. - Design: In a prospective, longitudinal, observational, multicenter study of incident dialysis patients, the 7-point SGA [7 = normal nutritional status; 1 = severe protein-energy wasting (PEW)] was assessed 3 and 6 mo after the start of dialysis and subsequently every 6 mo during 7 y of follow-up. With Cox regression analysis, we calculated hazard ratios (HRs) of the baseline and time-dependent SGA measurements, adjusted for age, sex, treatment modality, primary kidney diseases, and comorbidity. - Results: In total, 1601 patients were included [mean (±SD) age: 59 ± 15 y; 61% men; 23% with moderate PEW (SGA4–5), and 5% with severe PEW (SGA1–3)]. There was a dose-dependent trend of the 7-point SGA with mortality. Compared with a normal nutritional status at baseline, SGA4–5 (HR: 1.6; 95% CI: 1.3, 1.9) and SGA1–3 (HR: 2.1; 95% CI: 1.5, 2.8) were associated with an increase in 7-y mortality. Time-dependently, these associations were stronger: SGA4–5 (HR: 2.1; 95% CI: 1.7, 2.5) and SGA1–3 (HR: 5.0; 95% CI: 3.8, 6.5). - Conclusions: In dialysis patients, PEW at baseline assessed with SGA was associated with a 2-fold increased mortality risk in 7 y of follow-up. Time-dependently, this association was even stronger, which indicated that PEW was associated with a remarkably high risk of short-term mortality. These data imply that the 7-point SGA may validly distinguish different degrees of PEW associated with increasing risks of mortality.

AB - Background: The subjective global assessment of nutritional status (SGA) is used to assess the nutritional status of chronic dialysis patients, but longitudinal data in relation to mortality risk are lacking. - Objective: Our objective was to study the long-term and time-dependent associations of the SGA with mortality risk in chronic dialysis patients. - Design: In a prospective, longitudinal, observational, multicenter study of incident dialysis patients, the 7-point SGA [7 = normal nutritional status; 1 = severe protein-energy wasting (PEW)] was assessed 3 and 6 mo after the start of dialysis and subsequently every 6 mo during 7 y of follow-up. With Cox regression analysis, we calculated hazard ratios (HRs) of the baseline and time-dependent SGA measurements, adjusted for age, sex, treatment modality, primary kidney diseases, and comorbidity. - Results: In total, 1601 patients were included [mean (±SD) age: 59 ± 15 y; 61% men; 23% with moderate PEW (SGA4–5), and 5% with severe PEW (SGA1–3)]. There was a dose-dependent trend of the 7-point SGA with mortality. Compared with a normal nutritional status at baseline, SGA4–5 (HR: 1.6; 95% CI: 1.3, 1.9) and SGA1–3 (HR: 2.1; 95% CI: 1.5, 2.8) were associated with an increase in 7-y mortality. Time-dependently, these associations were stronger: SGA4–5 (HR: 2.1; 95% CI: 1.7, 2.5) and SGA1–3 (HR: 5.0; 95% CI: 3.8, 6.5). - Conclusions: In dialysis patients, PEW at baseline assessed with SGA was associated with a 2-fold increased mortality risk in 7 y of follow-up. Time-dependently, this association was even stronger, which indicated that PEW was associated with a remarkably high risk of short-term mortality. These data imply that the 7-point SGA may validly distinguish different degrees of PEW associated with increasing risks of mortality.

KW - IR-76910

KW - METIS-261025

U2 - 10.3945/​ajcn.2008.26970

DO - 10.3945/​ajcn.2008.26970

M3 - Article

VL - 89

SP - 787

EP - 793

JO - American journal of clinical nutrition

JF - American journal of clinical nutrition

SN - 0002-9165

IS - 3

ER -