Abstract: Objective To investigate protein- energy wasting (PEW) status and its related factors in maintenance dialysis patients. Methods A total of 154 maintenance dialysis patients (88 males and 66 females; 25-72 years old; 56 peritoneal dialysis patients and 98 hemodialysis patients) treated in Taixing People's Hospital during the period from Mar. 2012 to Mar. 2015 were enrolled in this study. PEW status was assessed by Modified Quantitative Subjective and Global Assessment (MQSGA), Malnutrition- Inflammation Score (MIS) and serum albumin level. Inflammation status including serum hypersensitive C-reactive protein (hsCRP), tumor necrosis factor (TNF-α) and interleukin 6 (IL-6) were measured by enzyme-linked immunoassay (ELISA). Anthropometrical parameters including body height, body weight, body mass index (BMI), mid- arm circumference (MAC), triceps skin-fold (TSF), and mid-arm muscle circumference (MAMC) were measured. Serological markers including total protein (TP), albumin, prealbumin (PA), hemoglobin (Hb), transferring (TF), creatinine (Scr), urea nitrogen (BUN), total cholesterol (Tch) were also assayed. The diagnosis of PEW was made base on the standards from International Society of Renal Nutrition and Metabolism (ISRNM). The patients were then divided into PEW group (n=61) and non-PEW group (n=93). Results ①PEW was found in 61 (39.6%) maintenance dialysis patients. PEW was found in 40 (40.8%) hemodialysis patients and 21 (37.5%) peritoneal dialysis patients without statistical significance between the two groups (χ2=0.163, P=0.685). ②The ratio of diabetic nephropathy was more in PEW group than in non-PEW group (χ2=5.750, P= 0.016). Age (t=5.666, P＜0.001), dialysis duration (t=7.718, P＜0.001), hsCRP (t=5.849, P＜0.001), TNF-α (t=7.384, P＜0.001), and IL-6 (t=7.650, P＜0.001) were higher in PEW group than in non-PEW group, while BMI (t=2.514, P =0.006), TP (t=7.237, P＜0.001), Alb (t=2.905, P =0.001), PA (t=9.168, P＜0.001), TF (t= 2.890, P=0.002), Hb (t=5.791, P＜0.001), Tch (t=3.048, P=0.001), MAC (t=2.640, P =0.004), MAMC (t= 1.781, P=0.038), and the proportion of Kt/V≥1.2 (χ2=9.518, P= 0.002) were lower in PEW group than in non- PEW group. ③ Multifactorial analyses showed that advanced age (OR=1.442, 95% CI=1.234～4.031, P= 0.027), longer dialysis duration (OR=1.442, 95% CI=1.234～4.031, P=0.027), inflammatory state, hypoalbuminemia (OR=3.231, 95% CI=1.453～4.346, P=0.028), and Kt/V<1.2 were the independent risk factors for PEW. Conclusion PEW was frequently seen in maintenance dialysis patients. Advanced age, longer dialysis duration, inflammatory state, and inadequate dialysis were the independent risk factors for PEW.

Key words: maintenance dialysis, protein energy wasting, malnutrition - inflammation score