Risk factor analysis and prediction model construction for malnutrition in chronic kidney disease inpatients_West China Medical Journal

Authors：

LI Xueqin , CHEN Chongcheng , LUO Yan , WANG Fang , ZHOU Xueli , ZHOU Qin , WANG Hui ,  MA Dengyan

Department of Nephrology, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

MA Dengyan, Email: mdy5104@163.com

Keywords：

Chronic kidney disease; Nutritional Risk Screening 2002; malnutrition; risk factors; prediction model

DOI：

10.7507/1002-0179.202212048

Video：

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Objective To investigate the nutritional status of hospitalized patients with chronic kidney disease (CKD), analyze the influencing factors, and construct a predictive model to provide a localized theoretical basis and more convenient risk prediction indicators and models for clinical nutrition support and intervention treatment of CKD patients in China. Methods Convenience sampling was used to select hospitalized CKD patients from Department of Nephrology, West China Hospital, Sichuan University, from January to October 2019. General information questionnaires, the Nutritional Risk Screening 2002 scale, and the Huaxi Emotional-distress Index questionnaire were used for data collection. Single factor analyses and multiple logistic regression analysis were conducted to explore the risk factors for malnutrition in CKD hospitalized patients. A predictive model was established and evaluated using receiver operating characteristic (ROC) curve analysis and bootstrap resampling. Results A total of 1059 valid copies of questionnaires were collected out of 1118 distributed. Among the 1059 CKD hospitalized patients, 207 cases (19.5%) were identified as having nutritional risk. The multiple logistic regression analysis showed that CKD stage [odds ratio (OR)=1.874, 95% confidence interval (CI) (1.631, 2.152), P<0.001], age [OR=1.015, 95%CI (1.003, 1.028), P=0.018], and the Huaxi Emotional-distress Index [OR=1.024, 95%CI (1.002, 1.048), P=0.033] were independent risk factors for malnutrition in CKD hospitalized patients, while serum albumin [OR=0.880, 95%CI (0.854, 0.907), P<0.001] was an independent protective factor. The evaluation of the multiple logistic regression analysis predictive model showed a concordance index of 0.977, standard deviation of 0.021, and P<0.05. The area under the ROC curve was 0.977. Conclusions The prevalence of malnutrition is relatively high among CKD hospitalized patients. CKD stage, age, psychological status, and serum albumin are influencing factors for malnutrition in CKD hospitalized patients. The multiple logistic regression model based on the above indicators demonstrates good predictive performance and is expected to provide assistance for early nutritional intervention to improve the clinical outcomes and quality of life for CKD patients with malnutrition in China.

Citation： LI Xueqin, CHEN Chongcheng, LUO Yan, WANG Fang, ZHOU Xueli, ZHOU Qin, WANG Hui, MA Dengyan. Risk factor analysis and prediction model construction for malnutrition in chronic kidney disease inpatients. West China Medical Journal, 2023, 38(7): 1014-1020. doi: 10.7507/1002-0179.202212048 Copy

1.	Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Glob Health, 2016, 4(5): e307-e319.
2.	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
3.	中國醫師協會腎臟內科醫師分會, 中國中西醫結合學會腎臟疾病專業委員會營養治療指南專家協作組. 中國慢性腎臟病營養治療臨床實踐指南（2021 版）. 中華醫學雜志, 2021, 101(8): 539-559.
4.	Chung HF, Al Mamun A, Huang MC, et al. Obesity, weight change, and chronic kidney disease in patients with type 2 diabetes mellitus: a longitudinal study in Taiwan. J Diabetes, 2017, 9(11): 983-993.
5.	Zhu Y, Liu X, Li N, et al. Association between iron status and risk of chronic kidney disease in Chinese adults. Front Med (Lausanne), 2020, 6: 303.
6.	Jagadeswaran D, Indhumathi E, Hemamalini AJ, et al. Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients. Clin Nutr, 2019, 38(1): 341-347.
7.	方仕, 麥海妍, 盧味, 等. 住院患者營養風險篩查及營養支持狀況. 中國公共衛生, 2010, 26(5): 574-575.
8.	劉曉琴, 陳英. 慢性腎臟病患者營養管理的研究進展. 中西醫結合護理(中英文), 2019, 5(5): 229-232.
9.	Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr, 2017, 36(3): 623-650.
10.	湯亞箐, 劉爽, 但丹, 等. 膀胱癌根治性切除并回腸尿流改道住院患者營養風險篩查. 四川醫學, 2022, 43(4): 317-320.
11.	National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis, 2002, 39(2 Suppl 1): S1-266.
12.	中國肥胖問題工作組數據匯總分析協作組. 我國成人體重指數和腰圍對相關疾病危險因素異常的預測價值: 適宜體重指數和腰圍切點的研究. 中華流行病學雜志, 2002, 23(1): 5-10.
13.	Wang J, Guo WJ, Zhang L, et al. The development and validation of Huaxi emotional-distress index (HEI): a Chinese questionnaire for screening depression and anxiety in non-psychiatric clinical settings. Compr Psychiatry, 2017, 76: 87-97.
14.	孟憲東, 高猛, 李濤, 等. 華西心情指數量表在護理人員中應用的信度與效度研究. 中國護理管理, 2017, 17(3): 310-312.
15.	Müller M, Dahdal S, Saffarini M, et al. Evaluation of Nutrition Risk Screening Score 2002 (NRS) assessment in hospitalized chronic kidney disease patient. PLoS One, 2019, 14(1): e0211200.
16.	祝金城, 趙存喜, 張海峰. 慢性腎臟病患者透析前營養狀況及營養不良影響因素分析. 中華全科醫學, 2019, 17(12): 2026-2030.
17.	Iorember FM. Malnutrition in chronic kidney disease. Front Pediatr, 2018, 6: 161.
18.	陳懿, 柳園, 石運瑩. 營養管理策略在慢性腎臟病中的應用. 華西醫學, 2021, 36(7): 959-963.
19.	陳科威, 徐曉珍, 葛玉英, 等. 血液透析患者透析護理期間營養評估與專病一體化飲食指導效果探析. 中國血液凈化, 2020, 19(6): 424-426.
20.	陳靖, 張倩. 老年慢性腎臟病患者營養管理. 腎臟病與透析腎移植雜志, 2019, 28(6): 548-549.
21.	王文寧, 張晴, 尹新娟. 營養風險篩查在老年慢性腎臟病患者營養評估中的應用. 現代醫藥衛生, 2022, 38(11): 1843-1845, 1849.
22.	王饒萍, 唐春苑, 鐘宇芳, 等. 維持性血液透析患者焦慮和抑郁狀態與營養狀況臨床分析. 中國中西醫結合腎病雜志, 2014(10): 886-888.
23.	趙春艷, 嚴保平, 曹小會, 等. 老年尿毒癥透析患者焦慮的影響因素觀察. 國際精神病學雜志, 2018, 45(4): 715-716, 725.
24.	陳玉潔. 5 期慢性腎臟病患者營養狀況與健康素養、焦慮/抑郁情緒的相關性研究. 長沙: 湖南師范大學, 2019.
25.	董雅夢, 王菁, 翟珊珊, 等. 個性化心理護理對慢性腎病維持性血液透析患者情緒癥狀和生活質量的影響. 國際精神病學雜志, 2018, 45(6): 1138-1141.
26.	Carrero JJ, Stenvinkel P, Cuppari L, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr, 2013, 23(2): 77-90.
27.	Caraceni P, Domenicali M, Tovoli A, et al. Clinical indications for the albumin use: still a controversial issue. Eur J Intern Med, 2013, 24(8): 721-728.
28.	楊雄, 高偉, 邱萬勝, 等. 白蛋白球蛋白比值對慢性腎臟病患者預后判斷的價值研究. 陜西醫學雜志, 2020, 49(6): 728-731.
29.	Kaysen GA. Serum albumin concentration in dialysis patients: why does it remain resistant to therapy?. Kidney Int Suppl, 2003(87): S92-S98.
30.	李杰, 劉鐵. 復方 α-酮酸治療慢性腎病蛋白尿的療效分析. 陜西醫學雜志, 2016, 45(12): 1663-1664.

1. Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Glob Health, 2016, 4(5): e307-e319.
2. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
3. 中國醫師協會腎臟內科醫師分會, 中國中西醫結合學會腎臟疾病專業委員會營養治療指南專家協作組. 中國慢性腎臟病營養治療臨床實踐指南（2021 版）. 中華醫學雜志, 2021, 101(8): 539-559.
4. Chung HF, Al Mamun A, Huang MC, et al. Obesity, weight change, and chronic kidney disease in patients with type 2 diabetes mellitus: a longitudinal study in Taiwan. J Diabetes, 2017, 9(11): 983-993.
5. Zhu Y, Liu X, Li N, et al. Association between iron status and risk of chronic kidney disease in Chinese adults. Front Med (Lausanne), 2020, 6: 303.
6. Jagadeswaran D, Indhumathi E, Hemamalini AJ, et al. Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients. Clin Nutr, 2019, 38(1): 341-347.
7. 方仕, 麥海妍, 盧味, 等. 住院患者營養風險篩查及營養支持狀況. 中國公共衛生, 2010, 26(5): 574-575.
8. 劉曉琴, 陳英. 慢性腎臟病患者營養管理的研究進展. 中西醫結合護理(中英文), 2019, 5(5): 229-232.
9. Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr, 2017, 36(3): 623-650.
10. 湯亞箐, 劉爽, 但丹, 等. 膀胱癌根治性切除并回腸尿流改道住院患者營養風險篩查. 四川醫學, 2022, 43(4): 317-320.
11. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis, 2002, 39(2 Suppl 1): S1-266.
12. 中國肥胖問題工作組數據匯總分析協作組. 我國成人體重指數和腰圍對相關疾病危險因素異常的預測價值: 適宜體重指數和腰圍切點的研究. 中華流行病學雜志, 2002, 23(1): 5-10.
13. Wang J, Guo WJ, Zhang L, et al. The development and validation of Huaxi emotional-distress index (HEI): a Chinese questionnaire for screening depression and anxiety in non-psychiatric clinical settings. Compr Psychiatry, 2017, 76: 87-97.
14. 孟憲東, 高猛, 李濤, 等. 華西心情指數量表在護理人員中應用的信度與效度研究. 中國護理管理, 2017, 17(3): 310-312.
15. Müller M, Dahdal S, Saffarini M, et al. Evaluation of Nutrition Risk Screening Score 2002 (NRS) assessment in hospitalized chronic kidney disease patient. PLoS One, 2019, 14(1): e0211200.
16. 祝金城, 趙存喜, 張海峰. 慢性腎臟病患者透析前營養狀況及營養不良影響因素分析. 中華全科醫學, 2019, 17(12): 2026-2030.
17. Iorember FM. Malnutrition in chronic kidney disease. Front Pediatr, 2018, 6: 161.
18. 陳懿, 柳園, 石運瑩. 營養管理策略在慢性腎臟病中的應用. 華西醫學, 2021, 36(7): 959-963.
19. 陳科威, 徐曉珍, 葛玉英, 等. 血液透析患者透析護理期間營養評估與專病一體化飲食指導效果探析. 中國血液凈化, 2020, 19(6): 424-426.
20. 陳靖, 張倩. 老年慢性腎臟病患者營養管理. 腎臟病與透析腎移植雜志, 2019, 28(6): 548-549.
21. 王文寧, 張晴, 尹新娟. 營養風險篩查在老年慢性腎臟病患者營養評估中的應用. 現代醫藥衛生, 2022, 38(11): 1843-1845, 1849.
22. 王饒萍, 唐春苑, 鐘宇芳, 等. 維持性血液透析患者焦慮和抑郁狀態與營養狀況臨床分析. 中國中西醫結合腎病雜志, 2014(10): 886-888.
23. 趙春艷, 嚴保平, 曹小會, 等. 老年尿毒癥透析患者焦慮的影響因素觀察. 國際精神病學雜志, 2018, 45(4): 715-716, 725.
24. 陳玉潔. 5 期慢性腎臟病患者營養狀況與健康素養、焦慮/抑郁情緒的相關性研究. 長沙: 湖南師范大學, 2019.
25. 董雅夢, 王菁, 翟珊珊, 等. 個性化心理護理對慢性腎病維持性血液透析患者情緒癥狀和生活質量的影響. 國際精神病學雜志, 2018, 45(6): 1138-1141.
26. Carrero JJ, Stenvinkel P, Cuppari L, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr, 2013, 23(2): 77-90.
27. Caraceni P, Domenicali M, Tovoli A, et al. Clinical indications for the albumin use: still a controversial issue. Eur J Intern Med, 2013, 24(8): 721-728.
28. 楊雄, 高偉, 邱萬勝, 等. 白蛋白球蛋白比值對慢性腎臟病患者預后判斷的價值研究. 陜西醫學雜志, 2020, 49(6): 728-731.
29. Kaysen GA. Serum albumin concentration in dialysis patients: why does it remain resistant to therapy?. Kidney Int Suppl, 2003(87): S92-S98.
30. 李杰, 劉鐵. 復方 α-酮酸治療慢性腎病蛋白尿的療效分析. 陜西醫學雜志, 2016, 45(12): 1663-1664.

West China Medical Journal

Risk factor analysis and prediction model construction for malnutrition in chronic kidney disease inpatients

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