Adapted GLIM Versus SGA for Assessing Malnutrition in Hemodialysis Patients

Malnutrition in patients with chronic kidney disease (CKD) can refer to both undernutrition and overnutrition, both of which can have negative effects. Undernutrition (body mass index [BMI] <18.5 kg/m²) is associated with higher morbidity, longer hospital stays, rehospitalization, lower quality of life, refractory anemia, fragility, and sarcopenia. Overnutrition, obesity in particular, can lead to hypertension, diabetes, and cardiovascular disease, all of which exacerbate CKD.

The prevalence of undernutrition among hemodialysis patients worldwide is 43%. However, data on obesity rates among CKD patients is lacking.

Ghumayra Aziz and colleagues sought to distinguish whether adapted Global Leadership Initiative on Malnutrition (GLIM) criteria could diagnose both overnutrition and undernutrition in patients on hemodialysis. In addition, the researchers compared the adapted GLIM criteria with the Subjective Global Assessment (SGA) for diagnosing undernutrition. The results of their cross-sectional, descriptive study appeared in the Journal of Renal Nutrition.

The study included information from an interviewer-administered questionnaire completed by 116 adult participants from two public renal units in Cape Town, South Africa; 58% were female and the mean age was 41.04 years (standard deviation [SD] 10.6). The data included demographic, medical, and anthropometric information, incorporating the adapted GLIM criteria and the established SGA tool.

Among the study participants, the primary causes of renal failure were hypertension (38%) and glomerular disease (33%). The median patient weight was 64.74 kg (interquartile range, 16.4) and the mean BMI was 25.44 kg/m² (SD 4.66). Assessed by BMI, 20% of participants had obesity and 4% had undernutrition. In addition, 51% had abdominal obesity, with a mean waist circumference of 87.06 cm (SD 11.37).

According to SGA parameters, 26% had undernutrition (classified as SGA-B) compared with 22% according to the adapted GLIM measure. The adapted GLIM measure also categorized 69.83% as malnourished, with 47% overnutrition and 22% undernutrition. Adapted GLIM had 75% sensitivity (CI 64.04, 85.96), 77.78% specificity (CI 67.26, 88.3), 69.23% (CI 57.55, 80.91) positive predictive value, and 82.35% (CI 72.71, 92.00) negative predictive value for undernutrition. Notably, 89% of patients diagnosed with overnutrition by GLIM were categorized as well-nourished by SGA.

In conclusion, the adapted GLIM criteria were effective for assessing overnutrition as well as undernutrition in hemodialysis patients. The GLIM criteria identified a significant proportion of patients that SGA incorrectly classified as well-nourished but were in fact overnourished. “The adapted GLIM showed good sensitivity and specificity for diagnosing undernutrition in this population,” the authors wrote.

Source: Journal of Renal Nutrition