Research On The Relationship Between Protein-energy Wasting And Dietary Intake In Patients With Chronic Kidney Disease And Early Warning

Objective To acquire the compliance rate of nutrients,the incidence of protein-energy wasting（PEW）and dietary pattern by diet investigation in paitents with chronic kidney disease（CKD）.Analyzing the relevant risk factors of PEW and researching the early warning of PEW.Methods The study enrolled patients with CKD in Lanzhou University Second Hospital,and the number of patients was 354,93,93 and 114 in four parts,respectively.They were divided into5 stages by K/DOQI guideline in 2002,and according to the PEW diagnostic criteria by ISRNM recommended in 2008,patients were divided into the PEW group and the non-PEW group.We collected the clinical indexs,anthropometrics data and food consumption data in three days,which was analyzed by Shanghai Zhengding Technology Health Management System.While peripheral blood was collected from patients,and five indicators of FGF23,Pin1,Wnt1,β-Catenin,and DKK1were measured by double antibody sandwich enzyme-linked immunosorbent assay and real-time quantitative PCR.Using SPSS21.0 statistical software to analyze the data.Results1.Part 1 Analysis on the protein-energy wasting among patients with chronic kidney diseaseThe study included 354 patients divided in CKD1⁵ stages.The number of patients reached the energy recommendation was 88 and totally compliance rate was 24.8 percent while protein recommendation was 32（9%）;and there were 51 patients with CKD reaching the recommendation about 14.4 percent.Carbohydrate up to recommendation was for 88 patients and compliance rate was 24.9 percent.The patients for clinical indexs of albumin and hemoglobin up to the standard was173（33.1%）and 117（32.1%）,respectively.The number of patients reached the body mass index（BMI）recommendation was 165 and compliance rate was 46.6 percent.There were 151patients with PEW about 56.6 percent,and the incidence of PEW in 267 patients with the stages CKD1⁵ was 6.2%,29.6%,42.15%,50.0%and 70.9%,successively.In total,these indexes mentioned above was gradually decreased but the incidence of PEW was increased with the progress of CKD.2.Part 2 Investigating the diet of patients with chronic kidney diseaseThe results for the research about dietary in 93 CKD patients showed that forty patients（43%）had no dietary guidance,while six patients（7%）were consulted online,and forty-seven patients（50%）were guided by specialist dietitian in nephrology department.The intake of protein,carbohydrate,sodium and phosphorus were exceeded,while dietary fiber,calcium,iodine and folic acid were less than 50%to the standard.Protein sources by non-high quality plant protein,animal protein and legumes were statistically significant（F=123.02,P<0.001）.The vegetable and poultry groups gradually decreased with the development of CKD,and there was statistically significant difference between the groups（P<0.05）.Patients with CKD1⁵ stages were mainly served with lunch and dinner,but the proportion of energy for breakfast was low.3.Part 3 Analysis on the related factors of protein-energy wasting in patients with chronic kidney diseaseThere were 28 cases with PEW in 93 CKD patients,and the incidence rate of PEW in CKD1⁵ stages was 10.3%,10.0%,32.0%,43.8%and 69.2%.Compared with the non-PEW group,BMI,weight,and weight loss,albumin,cholesterol,serum creatinine,eGFR,body fat ratio,arm muscle circumference（AMC）,subscapular skinfold（SSF）,grip strength,total energy,protein,carbohydrates,dietary fiber,folic acid,iron,selenium,copper,manganese,zinc,potassium,phosphorus,vitamin B₁,iodine,nicotinic acid and amino acids all had statistical significance（P<0.05）.Multivariate logistic regression analysis showed that the decasesed prealbumin,cholesterol,eGFR,BMI and grip strength,and insufficient staple food,total energy and potassium probably were all risk factors for PEW.4.Part 4 Research on the relationship between bone specific molecular markers and protein-energy wasting in patients with chronic kidney diseaseCompared with the non-PEW group,there were significantly decreased in albumin,cholesterol,eGFR in PEW group（P<0.05）,while the serum creatinine was increased（P<0.05）,and the proportion of patients with weight loss,dietary intake,or diabetes mellitus and cardiovascular disease in PEW group was higher（P<0.05）.Pearson correlation analysis showed that serum FGF23concentrations were significantly and positively correlated with PEW（r=0.281,P=0.049）.Univariate and multivariate logistic regression analysis indicated that serum FGF23 and Wnt1 were the independent predictor of PEW.The area under ROC curve was used to estimate the diagnostic critical value of PEW and the area under ROC curve serum FGF23 was 0.659,and the area under ROC curve serum Wnt1 was 0.593.In contrast,there was no correlation between the five markers in RNA levels and PEW.Conclusions1.Nutritional therapy has not been paid enough attention to patients with CKD.Under the progress of CKD,the dietary intake is significent deficiency and the dietary structure is not reasonable.2.The incidence of PEW in patients with CKD gradually increases with the progress of disease.It is possiblely that the decasesed prealbumin,cholesterol,eGFR,BMI and grip,and insufficient staple food,total energy and potassium are all the risk factors of PEW.3.The incidence of PEW is gradually increased with the progress of CKD.FGF23 is expected to be a serological marker of early diagnosis of PEW,while the relationship of Wnt signaling pathway associated proteins and PEW requires further study to confirm.4.All patients with CKD need to implement target nutrition management by practicing individual dietary guidance and goal nutrition therapy.