Protein-energy wasting in chronic kidney disease patients not receiving kidney replacement therapy: risk factors for all-cause death and composite outcomes: findings from KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD)

作者：Lee H, Lee H, Ryu H, Kang M, Kang E, Kim M, Kim SM, Kim JH, Jeong Y, Jung JY, Jeong JC, Park SK, Yoo TH, Yang SJ, Oh KH, KNOW-CKD Investigators · 发表于：Kidney research and clinical practice · 年份：2025 · DOI：10.23876/j.krcp.25.112

BACKGROUND: Protein-energy wasting (PEW) is a strong indicator of adverse outcomes such as all-cause death and cardiovascular events. Although this association has been established in dialysis patients, it has not been clearly demonstrated in those with non-dialysis-dependent chronic kidney disease (NDD-CKD). This study aimed to evaluate the association between PEW and all-cause death or cardiovascular events in patients with NDD-CKD. METHODS: We investigated the association between PEW and adverse outcomes in patients with NDD-CKD through a prospective cohort study of 1,847 patients (median follow-up: 6.94 years). The definition of PEW followed the International Society of Renal Nutrition and Metabolism criteria: serum albumin <3.8 g/dL, body mass index <23.0 kg/m2, skeletal muscle mass <19.7 kg in women, <26.9 kg in men, and protein intake <0.6 g/kg/day. RESULTS: During follow-up, 129 deaths and 264 composite outcomes (all-cause death or cardiovascular events) occurred. In Cox regression analysis, all-cause death and composite outcomes were significantly increased in patients with two or more PEW parameters. All-cause death was significantly increased in patients with two PEW parameters (hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.61-4.08; p < 0.001) or ≥3 PEW parameters (HR, 3.78; 95% CI, 1.81-7.89; p < 0.001). Composite outcomes were also significantly increased in patients with two PEW parameters (HR, 2.16; 95% CI, 1.51-3.11; p < 0.001) or ≥3 PEW parameter...