The Effect of Malnutrition, Inflammatory Biomarkers, and Stress-Induced Hyperglycemia on the Glomerular Filtration Rate in Renal Dysfunction

초록

Background: The risk of malnutrition can be assessed using the prognostic nutritional index (PNI) and the controlling nutritional status (CONUT) score. The stress hyperglycemia ratio (SHR) is a useful marker for assessing stress-induced hyperglycemia (SIH). This study examined the effects of malnutrition, SIH, and inflammatory biomarkers on the estimated glomerular filtration rate (eGFR) in patients with renal dysfunction.<br /> Methods: This study used the data obtained from 1815 patients with reduced eGFR. Serum amyloid A (SAA), procalcitonin, presepsin, C-reactive protein (CRP), and corrected erythrocyte sedimentation rate (cESR) were included as inflammatory biomarkers. The nutritional status was assessed using the PNI, CONUT score, and a new index, nutritional index of kidney diseases (NIKD). The CONUT scores >= 5.0 were defined as malnutrition. SIH was evaluated using the stress hyperglycemia ratio (SHR).<br /> Results: Patients with malnutrition had significantly lower eGFR than those without malnutrition, which was still significant even after excluding patients with inflammation. The eGFR was more strongly correlated with NIKD, SHR, procalcitonin, and presepsin than SAA and hemoglobin A1c. Procalcitonin, presepsin, and CRP levels were significantly higher in patients with moderately reduced eGFR than in those with mildly reduced eGFR. In contrast, the SAA and cESR levels were not significantly different between the two groups. After adjusting for potential confounders, low NIKD and high SHR were strongly associated with an increased risk of moderately reduced eGFR (odds ratio: 1.513, 95% confidence interval [CI], 1.074- 2.951; and 1.832, 95% CI, 1.274- 2.503, respectively, p < 0.001).<br /> Conclusion: Malnutrition and SIH are closely associated with a deterioration of kidney function. Measuring NIKD and SHR may provide additional information for monitoring potential disease progression in patients with renal dysfunction.

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