Prevalence of Protein-energy Wasting and Its Various Types in Iranian Hemodialysis Patients: A New Classification

Figures & data

Table 1. Characteristics of the HD patients and prevalence of PEW, and inadequate intakes of energy and protein.

Characteristics	All patients (n = 291)
Age (year)
18–40	45 (15.5%)
41–60	99 (34%)
>60	147 (50.5%)
Sex
Men	164 (56%)
Women	127 (44%)
Dialysis vintage (year)
≤1	60 (21%)
1–5	149 (51%)
5–10	61 (21%)
>10	21 (7%)
Dialysis adequacy (Kt/V)
<1.2	113 (46%)
≥1.2	133 (54%)
Diabetes	114 (39%)
Hepatitis C	16 (5.5%)
Serum creatinine (mg/dL)	9 ± 0.2
Serum urea (mg/dL)	123 ± 1.7
Prevalence
Well nourished	112 (38.5%)
Mild-to-moderate PEW	175 (60.5%)
Severe PEW	3 (1%)
Inadequate energy intake	275 (88%)
Inadequate protein intake	246 (84.5%)

Note: Serum creatinine and urea are presented as mean ± standard error (SE).

Table 2. Prevalence of PEW in the HD patients based on different factors.

	PEW
Variable	Yes	No	p-Value
Sex
Men	89 (54%)	75 (46%)	<0.01
Women	89 (71%)	37 (29%)
Age (year)
<60	59 (45%)	73 (55%)	<0.001
≥60	119 (75%)	39 (25%)
Dialysis vintage (year)
≤5	122 (59%)	86 (41%)	NS
>5	56 (68%)	26 (32%)
Dialysis adequacy (Kt/V)
≥1.2	86 (65%)	47 (35%)	NS
<1.2	67 (60%)	45 (40%)
Microinflammation
Yes (hs-CRP > 3 mg/L)	140 (67%)	69 (33%)	<0.01
No (hs-CRP ≤ 3 mg/L)	37 (46%)	43 (54%)
Dietary intakes of energy and protein
Adequate energy and protein intake	6 (33%)	12 (67%)	<0.05
Inadequate energy and/or protein intake	172 (63%)	100 (37%)

Note: NS, nonsignificant.

Table 3. Prevalence of various types of PEW and normal nutritional statuses in the HD patients and a comparison of their characteristics.

	Various types of PEW
Parameters	PEW type I (n = 36)	PEW type IIa (n = 115)	PEW type IIb (n = 25)
Prevalence (%)	20.5	65.5	14.0
Dietary energy intake (kcal/kgbw/d)	22 ± 1.2	21 ± 0.5	33 ± 1.0
Dietary protein intake (g/kgbw/d)	0.85 ± 0.05	0.79 ± 0.02	1.30 ± 0.04
Serum CRP (mg/L)	1.2 ± 0.1	7.5 ± 0.2**	7.1 ± 0.4**
Serum albumin (g/dL)	4.15 ± 0.04	3.98 ± 0.03**	3.98 ± 0.07
Dialysis vintage (month)	59 ± 10	53 ± 5.0	55 ± 7.5
Dialysis adequacy (Kt/V)	1.4 ± 0.07	1.2 ± 0.03	1.2 ± 0.07

	Various types of normal nutritional statuses
	Type 0 (n = 4)	Type I (n = 38)	Type IIa (n = 62)	Type IIb (n = 8)
Prevalence (%)	3.5	34.0	55.5	7.0
Dietary energy intake (kcal/kgbw/d)	40 ± 3.9	25 ± 1.2****	22 ± 0.8****	42 ± 3.1
Dietary protein intake (g/kgbw/d)	1.5 ± 0.17	0.9 ± 0.05****	0.8 ± 0.03****	1.6 ± 0.11
Serum CRP (mg/L)	0.9 ± 0.4	1.3 ± 0.1	6.6 ± 0.3*****	6.2 ± 0.7*****
Serum albumin (g/dL)	4.4 ± 0.08	4.4 ± 0.06	4.2 ± 0.04	4.2 ± 0.10
Dialysis vintage (month)	69 ± 17	51 ± 11	42 ± 4	61 ± 23
Dialysis adequacy (Kt/V)	1.1 ± 0.09	1.3 ± 0.06	1.17 ± 0.04	1.14 ± 0.15

Notes: All values are presented as mean ± SE, except prevalence.

*p < 0.01 versus type IIb; **p < 0.001 versus type I; ***p < 0.05 versus type I; ****p < 0.01 versus types 0 and IIb; and *****p < 0.001 versus types 0 and I.