GLIM criteria for definition of malnutrition in peritoneal dialysis: a new aspect of nutritional assessment

Figures & data

Figure 1. Flow chart of study subjects enrollment.

Table 1. Baseline characteristics of categories according to GLIM in all participants.

	All patients (n = 1057)	Well-nourished (n = 688)	Malnourished (n = 369)	p-vaule
Age (years)	56.1 ± 14.4	55.0 ± 14.8	58.2 ± 15.1	<0.001
Female, n (%)	464 (43.9)	306 (44.5)	158 (42.8)	0.649
Smoking, n (%)	201 (19.0)	136 (19.8)	65 (17.6)	0.412
Diabetes, n (%)	206 (19.5)	114 (16.6)	92 (24.9)	0.001
Cardiovascular disease, n (%)	276 (26.1)	129 (18.8)	147 (39.8)	<0.001
Systolic pressure (mmHg)	129 ± 38	128 ± 39	130 ± 33	0.403
Diastolic pressure (mmHg)	82 ± 26	80 ± 28	83 ± 22	0.075
Medicines
Antianaemic, n (%)	402 (38.0)	253 (36.8)	149 (40.4)	0.259
Statins, n (%)	280 (26.5)	172 (25.0)	108 (29.3)	0.144
Hypotensive agent, n (%)	873 (82.6)	562 (81.7)	311 (84.3)	0.308
Body mass index (kg/m^2)	22.0 ± 3.4	22.5 ± 4.1	21.6 ± 3.3	<0.001
Triceps skinfold thickness (mm)	15.1 ± 5.8	15.8 ± 6.1	13.9 ± 5.3	<0.001
Mid arm circumference (cm)	28.6 ± 4.2	29.3 ± 4.6	28.4 ± 4.0	0.002
MAMC (cm)	23.9 ± 3.1	24.4 ± 3.3	23.7 ± 3.1	<0.001
Edema				<0.001
None, n (%)	635 (60.1)	495 (71.9)	140 (37.9)
Mild, n (%)	331 (31.3)	164 (23.8)	167 (45.3)
Moderate-severe, n (%)	91 (8.6)	29 (4.2)	62 (16.8)
Hemoglobin (g/L)	86.6 ± 14.2	88.1 ± 15.1	85.7 ± 13.6	<0.001
Alanine aminotransferase (U/L)	22.1 ± 7.6	22.3 ± 8.0	21.9 ± 7.4	0.427
Serum albumin (g/L)	35.0 ± 5.2	35.5 ± 5.3	33.9 ± 5.0	<0.001
Prealbumin level (g/L)	0.3 ± 0.1	0.4 ± 0.1	0.2 ± 0.1	<0.001
Transferrin (g/L)	2.1 ± 0.7	2.2 ± 0.8	1.9 ± 0.6	<0.001
Total cholesterol (mmol/L)	5.42 ± 1.18	5.43 ± 1.21	5.36 ± 1.07	0.348
High-density lipoprotein (mmol/L)	1.24 ± 0.41	1.30 ± 0.45	1.28 ± 0.34	0.455
Low-density lipoprotein (mmol/L)	2.93 ± 1.02	3.01 ± 1.04	2.96 ± 0.99	0.449
Creatinine (umol/L)	769 ± 236	776 ± 248	758 ± 205	0.233
Calcium (mmol/L)	2.01 ± 0.27	1.99 ± 0.27	1.98 ± 0.26	0.561
Phosphate (mmol/L)	1.82 ± 0.56	1.81 ± 0.56	1.83 ± 0.57	0.582
Parathyroid hormone (pg/ml)	200 (101, 326)	195 (99, 327)	214 (111, 336)	0.496
C-reactive protein (mg/L)	0.7 (0.5, 1.2)	0.5 (0.3, 1.0)	1.0 (0.7, 1.6)	<0.001
Residual renal function (ml/min/1.73 m^2)	5.0 (4.1, 8.1)	5.2 (4.2, 8.5)	4.9 (4.1, 7.4)	0.208
D/Pcr	0.66 ± 0.21	0.65 ± 0.23	0.64 ± 0.20	0.481
Kt/Vurea,weekly totals	1.92 ± 0.65	1.93 ± 0.67	1.88 ± 0.52	0.213
nPNA (g/kg/day)	0.9 ± 0.3	1.0 ± 0.3	0.8 ± 0.2	<0.001
SGA	5.7 ± 0.9	6.1 ± 1.0	4.3 ± 0.8	<0.001
MIS	8.5 ± 0.8	7.3 ± 0.8	10.2 ± 0.9	<0.001
GNRI	93.7 ± 10.1	94.7 ± 9.9	91.9 ± 9.7	<0.001

MAMC: mid-arm muscle circumference calculated; D/Pcr: peritoneal transport characteristics index; Kt/Vurea: dialysis adequacy index; nPNA: normalized protein equivalent of total nitrogen appearance; SGA: subjective global assessment; MIS: malnutrition inflammation score; GNRI: geriatric nutritional risk index.

Figure 2. Conformance between GLIM and other nutrition assessment tools. a) Number and percentage of malnutrition diagnosed by various nutritional assessment tools. b) Intersection of the number of people diagnosed as positive for malnutrition various nutritional assessment tools. c) Concordance index (kappa) of various nutritional assessment tools for the diagnosis of malnutrition. GLIM: Global Leadership Initiative on Malnutrition; SGA: subjective global assessment; MIS: malnutrition inflammation score; GNRI: geriatric nutritional risk index.

Figure 3. Survival curves of GLIM and other nutrition measurement tools. GLIM: global leadership initiative on malnutrition; SGA: subjective global assessment; MIS: malnutrition inflammation score; GNRI: geriatric nutritional risk index.

Table 2. Hazard ratios for malnutrition diagnosed by GLIM and other nutrition measurement tools with overall mortality.

	Unadjusted			Model 1			Model 2
	HR	95% CI	p-value	HR	95% CI	p-value	HR	95% CI	p-value
GLIM	2.96	2.44 − 3.57	<0.001	2.94	2.42 − 3.56	<0.001	2.91	2.39 − 3.54	<0.001
SGA	2.26	1.87 − 2.72	<0.001	2.12	1.75 − 2.56	<0.001	2.14	1.77 − 2.59	<0.001
MIS	4.09	3.37 − 4.95	<0.001	4.03	3.31 − 4.92	<0.001	3.93	3.23 − 4.80	<0.001
GNRI	1.93	1.59 − 2.33	<0.001	1.84	1.52 − 2.22	<0.001	1.77	1.46 − 2.15	<0.001

Model 1: adjusted for age, sex, diabetes, cardiovascular disease and medicines; Model 2: adjusted for Model 1+ lipids, calcium, phosphate, parathyroid hormone, residual renal function, D/Pcr: C-reactive protein and Kt/Vurea; HR: adjusted hazard ratios; CI: confidence interval; GLIM: global leadership initiative on malnutrition; SGA: subjective global assessment; MIS: malnutrition inflammation score; GNRI: geriatric nutritional risk index.

Figure 4. Adjusted hazard ratios of all-cause mortality for malnutrition diagnosed by GLIM in different subgroups Kt/Vurea: dialysis adequacy index; HR: hazard ratio.

Figure 5. The ROC curves of GLIM and other nutrition measurement tools on mortality prediction. AUC: area under curve; GLIM: global leadership initiative on malnutrition; SGA: subjective global assessment; MIS: malnutrition inflammation score; GNRI, g:riatric nutritional risk index.

Table 3. Comparison of predictive performance in long-term survival of models matching GLIM and other nutrition measurement tools.

	NRI			IDI
Model	Estimate	95% CI	p-value	Estimate	95% CI	p-value
Adjusted factors + GLIM	Ref. Ref. Ref.			Ref. Ref. Ref.
Adjusted factor + SGA	−0.33	−0.39 − 0.27	0.211	−0.05	−0.09 − 0.01	0.082
Adjusted factors + MIS	0.24	0.03 − 0.40	0.018	0.06	0.01 − 0.12	0.040
Adjusted factors + GNRI	−0.31	−0.39 to −0.23	0.002	−0.05	−0.08 to −0.01	<0.001

NRI: net reclassification improvement; IDI: integrated discrimination improvement; GLIM: global leadership initiative on malnutrition; SGA: subjective global assessment; MIS: malnutrition inflammation score; GNRI: geriatric nutritional risk index; CI: confidence interval.

Data availability statement

All available data have been presented in the paper.