Assessment and comparison of protein-energy wasting (PEW) in maintenance hemodialysis (MHD) patients of different age groups in order to provide basis for clinical work.

A cross-sectional and retrospective study was performed. Assessment and comparison of PEW were made by means of objective score of nutrition on dialysis (OSND) and modified quantitative subjective global assessment (MQSGA) combining questionnaires, anthropometrics, blood biochemistry, and other indicators in the 242 patients of the adult group (aged < 65 years) and the 106 patients of the elderly group (aged ≥65 years). The PEW diagnosis criteria were as follows: the OSND score ≤22 points, the MQSGA score 21 to 35 points, the triceps skinfold thickness (TSF) <12.5 mm for males and <16.5 mm for females, the mid-upper arm circumference (MAC) <25.3 cm for males and <23.2 cm for females, albumin (ALB) <38 g/L, and the body mass index (BMI) <18.5 kg/m². The PEW was divided into mild, medium and severe grades according to the different scores and percentages of OSND, MQSGA, TSF, and MAC.

The incidence of PEW diagnosed by the OSND score, MQSGA score, TSF, MAC, ALB, and BMI was 79.3%, 67.8%, 43.9%, 23.0%, 43.1%, and 19.5%, respectively in all, but was 74.0%, 62.2%, 39.7%, 19.0%, 25.6%, and 17.8%, respectively in the adult group, and was 91.5%, 81.4%, 53.8%, 32.1%, 40.6%, and 23.5%, respectively in the elderly group. The incidence of severe PEW diagnosed by OSND, MQSGA, TSF, and MAC was 13.5%, 6.9%, 15.5%, and 3.7%, respectively. There were statistically significant differences in the incidence of PEW, and multiple baseline nutrition-related indicators between the two groups (P<0.05). The high-sensitivity C-reactive protein (hs-CRP) in the elderly group was significantly higher than in the adult group (P<0.05).

Compared with the ones of the adult group, the MHD patients of the elderly group had higher incidence of PEW, lower levels of nutritional indicators, and severer inflammatory status, indicating that PEW status of elderly dialysis patients should be more concerned in clinical work.