Outcome predictability of biomarkers of protein-energy wasting and inflammation in moderate and advanced chronic kidney disease
BACKGROUND: Markers of protein-energy wasting (PEW) and inflammation are common in chronic kidney disease (CKD) and are among the strongest predictors of mortality in dialysis patients. OBJECTIVE: We hypothesized that markers of PEW and inflammation show similar associations in patients with non-dia...
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| Veröffentlicht in: | The American journal of clinical nutrition 2009-08, Vol.90 (2), p.407-414 |
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| creator | Kovesdy, Csaba P George, Sajid M Anderson, John E Kalantar-Zadeh, Kamyar |
| description | BACKGROUND: Markers of protein-energy wasting (PEW) and inflammation are common in chronic kidney disease (CKD) and are among the strongest predictors of mortality in dialysis patients. OBJECTIVE: We hypothesized that markers of PEW and inflammation show similar associations in patients with non-dialysis-dependent CKD (NDD-CKD). DESIGN: We examined the associations of serum albumin, white blood cell (WBC) count, percentage of lymphocytes in WBCs (%LYM), and a combination of all 3 with all-cause mortality and with the composite of predialysis mortality or end-stage renal disease (ESRD) by using fixed-covariate and time-dependent Cox models in 1220 men with NDD-CKD. RESULTS: Lower albumin and %LYM and a higher WBC count were significantly associated with outcomes. In time-dependent Cox models, compared with patients in whom none of these markers indicated PEW, those in whom 1, 2, or all 3 markers indicated the presence of PEW had multivariable-adjusted hazard ratios (95% CI) for all-cause mortality of 1.7 (1.2, 2.4), 2.4 (1.7, 3.4), and 3.6 (2.5, 5.1); the P for trend was |
| doi_str_mv | 10.3945/ajcn.2008.27390 |
| format | Article |
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OBJECTIVE: We hypothesized that markers of PEW and inflammation show similar associations in patients with non-dialysis-dependent CKD (NDD-CKD). DESIGN: We examined the associations of serum albumin, white blood cell (WBC) count, percentage of lymphocytes in WBCs (%LYM), and a combination of all 3 with all-cause mortality and with the composite of predialysis mortality or end-stage renal disease (ESRD) by using fixed-covariate and time-dependent Cox models in 1220 men with NDD-CKD. RESULTS: Lower albumin and %LYM and a higher WBC count were significantly associated with outcomes. In time-dependent Cox models, compared with patients in whom none of these markers indicated PEW, those in whom 1, 2, or all 3 markers indicated the presence of PEW had multivariable-adjusted hazard ratios (95% CI) for all-cause mortality of 1.7 (1.2, 2.4), 2.4 (1.7, 3.4), and 3.6 (2.5, 5.1); the P for trend was <0.001. Similar associations were present in fixed-covariate models for all-cause mortality and in fixed-covariate and time-dependent models for the composite outcome. CONCLUSIONS: Traditional and nontraditional markers of PEW display robust, strong, and independent associations with mortality in patients with NDD-CKD. Clinical trials are warranted to examine whether PEW-improving interventions can lead to better outcomes in these patients.</description><identifier>ISSN: 0002-9165</identifier><identifier>EISSN: 1938-3207</identifier><identifier>DOI: 10.3945/ajcn.2008.27390</identifier><identifier>PMID: 19535427</identifier><identifier>CODEN: AJCNAC</identifier><language>eng</language><publisher>Bethesda, MD: American Society for Clinical Nutrition</publisher><subject>Aged ; Biological and medical sciences ; Biomarkers ; Biomarkers - blood ; blood composition ; Cause of Death ; chronic diseases ; dialysis ; Disease Progression ; Feeding. Feeding behavior ; Fundamental and applied biological sciences. Psychology ; Hemodialysis ; human nutrition ; human physiology ; Humans ; inflammation ; Inflammation - blood ; Inflammation - etiology ; Inflammation - mortality ; Kidney diseases ; Kidney Failure, Chronic - blood ; Kidney Failure, Chronic - complications ; Kidney Failure, Chronic - mortality ; Leukocyte Count ; Lymphocyte Count ; Male ; Mortality ; Nephrology ; Odds Ratio ; patients ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; protein energy ratio ; Protein-Energy Malnutrition - blood ; Protein-Energy Malnutrition - etiology ; Protein-Energy Malnutrition - mortality ; Proteins ; risk factors ; serum albumin ; Serum Albumin - metabolism ; Severity of Illness Index ; signs and symptoms (animals and humans) ; statistical analysis ; Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><ispartof>The American journal of clinical nutrition, 2009-08, Vol.90 (2), p.407-414</ispartof><rights>2009 INIST-CNRS</rights><rights>Copyright American Society for Clinical Nutrition, Inc. Aug 1, 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-41927d67ca63c6fcd7e15e9e352e86e2e96170c7a2e7d3b4dbe73cd5d50be3dc3</citedby><cites>FETCH-LOGICAL-c483t-41927d67ca63c6fcd7e15e9e352e86e2e96170c7a2e7d3b4dbe73cd5d50be3dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21797784$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19535427$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kovesdy, Csaba P</creatorcontrib><creatorcontrib>George, Sajid M</creatorcontrib><creatorcontrib>Anderson, John E</creatorcontrib><creatorcontrib>Kalantar-Zadeh, Kamyar</creatorcontrib><title>Outcome predictability of biomarkers of protein-energy wasting and inflammation in moderate and advanced chronic kidney disease</title><title>The American journal of clinical nutrition</title><addtitle>Am J Clin Nutr</addtitle><description>BACKGROUND: Markers of protein-energy wasting (PEW) and inflammation are common in chronic kidney disease (CKD) and are among the strongest predictors of mortality in dialysis patients. OBJECTIVE: We hypothesized that markers of PEW and inflammation show similar associations in patients with non-dialysis-dependent CKD (NDD-CKD). DESIGN: We examined the associations of serum albumin, white blood cell (WBC) count, percentage of lymphocytes in WBCs (%LYM), and a combination of all 3 with all-cause mortality and with the composite of predialysis mortality or end-stage renal disease (ESRD) by using fixed-covariate and time-dependent Cox models in 1220 men with NDD-CKD. RESULTS: Lower albumin and %LYM and a higher WBC count were significantly associated with outcomes. In time-dependent Cox models, compared with patients in whom none of these markers indicated PEW, those in whom 1, 2, or all 3 markers indicated the presence of PEW had multivariable-adjusted hazard ratios (95% CI) for all-cause mortality of 1.7 (1.2, 2.4), 2.4 (1.7, 3.4), and 3.6 (2.5, 5.1); the P for trend was <0.001. Similar associations were present in fixed-covariate models for all-cause mortality and in fixed-covariate and time-dependent models for the composite outcome. CONCLUSIONS: Traditional and nontraditional markers of PEW display robust, strong, and independent associations with mortality in patients with NDD-CKD. Clinical trials are warranted to examine whether PEW-improving interventions can lead to better outcomes in these patients.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Biomarkers</subject><subject>Biomarkers - blood</subject><subject>blood composition</subject><subject>Cause of Death</subject><subject>chronic diseases</subject><subject>dialysis</subject><subject>Disease Progression</subject><subject>Feeding. Feeding behavior</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Hemodialysis</subject><subject>human nutrition</subject><subject>human physiology</subject><subject>Humans</subject><subject>inflammation</subject><subject>Inflammation - blood</subject><subject>Inflammation - etiology</subject><subject>Inflammation - mortality</subject><subject>Kidney diseases</subject><subject>Kidney Failure, Chronic - blood</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Kidney Failure, Chronic - mortality</subject><subject>Leukocyte Count</subject><subject>Lymphocyte Count</subject><subject>Male</subject><subject>Mortality</subject><subject>Nephrology</subject><subject>Odds Ratio</subject><subject>patients</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>protein energy ratio</subject><subject>Protein-Energy Malnutrition - blood</subject><subject>Protein-Energy Malnutrition - etiology</subject><subject>Protein-Energy Malnutrition - mortality</subject><subject>Proteins</subject><subject>risk factors</subject><subject>serum albumin</subject><subject>Serum Albumin - metabolism</subject><subject>Severity of Illness Index</subject><subject>signs and symptoms (animals and humans)</subject><subject>statistical analysis</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><issn>0002-9165</issn><issn>1938-3207</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1v1DAQhi1ERZfCmRtYSHDL1h-xHR9RxUelSj2Uni3HnizeJvZiJ6A98dfxdlcg9WSN_Mxo5n0QekPJmutWXNqti2tGSLdmimvyDK2o5l3DGVHP0YoQwhpNpThHL0vZEkJZ28kX6JxqwUXL1Ar9uV1mlybAuww-uNn2YQzzHqcB9yFNNj9ALodql9MMITYQIW_2-Lctc4gbbKPHIQ6jnSY7hxRrgafkIdsZHj-t_2WjA4_dj5xicPgh-Ah77EMBW-AVOhvsWOD16b1A918-f7_61tzcfr2--nTTuLbjc9NSzZSXylnJnRycV0AFaOCCQSeBgZZUEacsA-V53_oeFHdeeEF64N7xC_TxOLfe8XOBMpspFAfjaCOkpRipBJFS6wq-fwJu05Jj3c0wXsMVRIgKXR4hl1MpGQazy6GGtTeUmIMYcxBjDmLMo5ja8fY0dukn8P_5k4kKfDgBtjg7DrmmFso_jlGllerayr07coNNxm5yZe7vGKGcVM8dFZz_BXgVoo4</recordid><startdate>20090801</startdate><enddate>20090801</enddate><creator>Kovesdy, Csaba P</creator><creator>George, Sajid M</creator><creator>Anderson, John E</creator><creator>Kalantar-Zadeh, Kamyar</creator><general>American Society for Clinical Nutrition</general><general>American Society for Nutrition</general><general>American Society for Clinical Nutrition, Inc</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T7</scope><scope>7TS</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20090801</creationdate><title>Outcome predictability of biomarkers of protein-energy wasting and inflammation in moderate and advanced chronic kidney disease</title><author>Kovesdy, Csaba P ; George, Sajid M ; Anderson, John E ; Kalantar-Zadeh, Kamyar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-41927d67ca63c6fcd7e15e9e352e86e2e96170c7a2e7d3b4dbe73cd5d50be3dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Biomarkers</topic><topic>Biomarkers - blood</topic><topic>blood composition</topic><topic>Cause of Death</topic><topic>chronic diseases</topic><topic>dialysis</topic><topic>Disease Progression</topic><topic>Feeding. Feeding behavior</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Hemodialysis</topic><topic>human nutrition</topic><topic>human physiology</topic><topic>Humans</topic><topic>inflammation</topic><topic>Inflammation - blood</topic><topic>Inflammation - etiology</topic><topic>Inflammation - mortality</topic><topic>Kidney diseases</topic><topic>Kidney Failure, Chronic - blood</topic><topic>Kidney Failure, Chronic - complications</topic><topic>Kidney Failure, Chronic - mortality</topic><topic>Leukocyte Count</topic><topic>Lymphocyte Count</topic><topic>Male</topic><topic>Mortality</topic><topic>Nephrology</topic><topic>Odds Ratio</topic><topic>patients</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>protein energy ratio</topic><topic>Protein-Energy Malnutrition - blood</topic><topic>Protein-Energy Malnutrition - etiology</topic><topic>Protein-Energy Malnutrition - mortality</topic><topic>Proteins</topic><topic>risk factors</topic><topic>serum albumin</topic><topic>Serum Albumin - metabolism</topic><topic>Severity of Illness Index</topic><topic>signs and symptoms (animals and humans)</topic><topic>statistical analysis</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kovesdy, Csaba P</creatorcontrib><creatorcontrib>George, Sajid M</creatorcontrib><creatorcontrib>Anderson, John E</creatorcontrib><creatorcontrib>Kalantar-Zadeh, Kamyar</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of clinical nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kovesdy, Csaba P</au><au>George, Sajid M</au><au>Anderson, John E</au><au>Kalantar-Zadeh, Kamyar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome predictability of biomarkers of protein-energy wasting and inflammation in moderate and advanced chronic kidney disease</atitle><jtitle>The American journal of clinical nutrition</jtitle><addtitle>Am J Clin Nutr</addtitle><date>2009-08-01</date><risdate>2009</risdate><volume>90</volume><issue>2</issue><spage>407</spage><epage>414</epage><pages>407-414</pages><issn>0002-9165</issn><eissn>1938-3207</eissn><coden>AJCNAC</coden><abstract>BACKGROUND: Markers of protein-energy wasting (PEW) and inflammation are common in chronic kidney disease (CKD) and are among the strongest predictors of mortality in dialysis patients. OBJECTIVE: We hypothesized that markers of PEW and inflammation show similar associations in patients with non-dialysis-dependent CKD (NDD-CKD). DESIGN: We examined the associations of serum albumin, white blood cell (WBC) count, percentage of lymphocytes in WBCs (%LYM), and a combination of all 3 with all-cause mortality and with the composite of predialysis mortality or end-stage renal disease (ESRD) by using fixed-covariate and time-dependent Cox models in 1220 men with NDD-CKD. RESULTS: Lower albumin and %LYM and a higher WBC count were significantly associated with outcomes. In time-dependent Cox models, compared with patients in whom none of these markers indicated PEW, those in whom 1, 2, or all 3 markers indicated the presence of PEW had multivariable-adjusted hazard ratios (95% CI) for all-cause mortality of 1.7 (1.2, 2.4), 2.4 (1.7, 3.4), and 3.6 (2.5, 5.1); the P for trend was <0.001. Similar associations were present in fixed-covariate models for all-cause mortality and in fixed-covariate and time-dependent models for the composite outcome. CONCLUSIONS: Traditional and nontraditional markers of PEW display robust, strong, and independent associations with mortality in patients with NDD-CKD. Clinical trials are warranted to examine whether PEW-improving interventions can lead to better outcomes in these patients.</abstract><cop>Bethesda, MD</cop><pub>American Society for Clinical Nutrition</pub><pmid>19535427</pmid><doi>10.3945/ajcn.2008.27390</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Biological and medical sciences Biomarkers Biomarkers - blood blood composition Cause of Death chronic diseases dialysis Disease Progression Feeding. Feeding behavior Fundamental and applied biological sciences. Psychology Hemodialysis human nutrition human physiology Humans inflammation Inflammation - blood Inflammation - etiology Inflammation - mortality Kidney diseases Kidney Failure, Chronic - blood Kidney Failure, Chronic - complications Kidney Failure, Chronic - mortality Leukocyte Count Lymphocyte Count Male Mortality Nephrology Odds Ratio patients Predictive Value of Tests Prognosis Proportional Hazards Models protein energy ratio Protein-Energy Malnutrition - blood Protein-Energy Malnutrition - etiology Protein-Energy Malnutrition - mortality Proteins risk factors serum albumin Serum Albumin - metabolism Severity of Illness Index signs and symptoms (animals and humans) statistical analysis Vertebrates: anatomy and physiology, studies on body, several organs or systems |
| title | Outcome predictability of biomarkers of protein-energy wasting and inflammation in moderate and advanced chronic kidney disease |
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