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. 2025 Dec;47(1):2441399.
doi: 10.1080/0886022X.2024.2441399. Epub 2024 Dec 18.

The correlation between protein energy wasting and the incidence of main adverse cardiovascular events in adult maintenance hemodialysis patients: a single-center retrospective cohort study

Xiaoyan Ma  1 , Danying Yan  1 , Canxin Zhou  1 , Yingfeng Shi  1 , Yi Wang  1 , Jinqing Li  1 , Qin Zhong  1 , Xialin Li  1 , Yan Hu  1 , Weiwei Liang  1 , Daofang Jiang  1 , Yishu Wang  1 , Ting Zhang  1 , Yilin Ruan  1 , Shasha Zhang  1 , Shougang Zhuang  1   2 , Na Liu  1
Affiliations

The correlation between protein energy wasting and the incidence of main adverse cardiovascular events in adult maintenance hemodialysis patients: a single-center retrospective cohort study

Xiaoyan Ma et al. Ren Fail. 2025 Dec.

Abstract

Background: Protein energy wasting (PEW) is prevalent in adult maintenance hemodialysis (MHD) patients. Concurrently, cardiovascular diseases (CVD) remain a leading cause of mortality in MHD patients. However, the relationship between PEW and CVD in MHD patients remains unclear.

Methods: We conducted a retrospective cohort study at Shanghai East Hospital. According to the inclusion and exclusion criteria, a total of 210 adult MHD patients were finally enrolled. Patients were categorized into two groups based on PEW diagnostic criteria, including 122 patients (58.1%) with PEW and 88 patients (41.9%) without PEW. We further analyzed the incidence of major adverse cardiovascular events (MACE) and all-cause mortality in one year, along with their risk factors.

Results: MACE incidence was significantly higher in the PEW group compared with the non-PEW group (p = 0.015). Multivariate Cox regression showed PEW, CVD, high N-terminal pro-B-type natriuretic peptide (NT-proBNP) and low Kt/V urea were the risk factors of MACE. Age ≥ 65 years and high NT-proBNP were the risk factors of all-cause death. Among patients aged ≥ 65 years, PEW was associated with a higher risk of all-cause death (p = 0.043). Total cholesterol < 3.4 mmol/L, albumin < 38 g/L and prealbumin < 280 mg/L were the thresholds for MACE incidence in MHD patients with PEW.

Conclusion: Adult MHD patients with PEW had an increased risk of MACE and all-cause mortality. Strategies aimed at optimizing total cholesterol, albumin, and prealbumin levels may improve cardiovascular outcomes in adult MHD patients with PEW.

Keywords: Protein energy wasting; hemodialysis; major adverse cardiovascular events; mortality; risk factors.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flowchart of the study. 260 adult maintenance hemodialysis patients were screened in the study, and 50 patients were excluded according to the exclusion criteria. 210 patients were finally enrolled, consisted of 122 patients with PEW and 88 patients with non-PEW. PEW: protein energy wasting.
Figure 2.
Figure 2.
The percentage of MHD patients with MACE between PEW and non-PEW. Histogram showed the percentage of MHD patients with more than 1 MACE in 1 year between the two groups. MACE: major adverse cardiovascular event; MHD: maintenance hemodialysis; PEW: protein energy wasting. P < 0.05 was considered to be statistically significant.
Figure 3.
Figure 3.
Association between MACE incidence and Kt/V urea and NT-proBNP with RCS curves in MHD patients. (A) The relationship of Kt/V urea and MACE incidence based on Cox proportional hazard models. The vertical dashed line indicates the cutoff value of 1.28 mmol/L. (B) The relationship of NT-proBNP and MACE incidence based on Cox proportional hazard models. The vertical dashed line indicates the cutoff value of 4380 ng/mL. HR: hazard ration; Kt/V urea: urea clearance index; MACE: major adverse cardiovascular event; MHD: maintenance hemodialysis; NT-proBNP: N-terminal pro-B-Type Natriuretic Peptide; RCS: restricted cubic spline.
Figure 4.
Figure 4.
Kaplan-Meier curve for the MACE in MHD patients with PEW and with non-PEW. Kaplan-Meier curve was shown for the proportion of cumulative MACE incidence during the follow-up period in MHD patients with PEW compared with patients with non-PEW. MACE: major adverse cardiovascular event; MHD: maintenance hemodialysis; PEW: protein energy wasting; 95% CI: 95% confidence interval; HR: hazard ratio. P < 0.05 was considered to be statistically significant.
Figure 5.
Figure 5.
Kaplan-Meier curve for the all-cause death in MHD patients aged ≥ 65 with PEW and with non-PEW. Kaplan-Meier curve was shown for the proportion of cumulative all-cause death during the follow-up period in hemodialysis patients aged 65 years or older with PEW compared with patients without PEW. MHD: maintenance hemodialysis; PEW: protein energy wasting; 95% CI: 95% confidence interval; HR: hazard ratio. P < 0.05 was considered to be statistically significant.
Figure 6.
Figure 6.
Association between MACE incidence and albumin, prealbumin and TC with RCS curves in MHD patients with PEW. (A) The relationship of TC and MACE incidence based on Cox proportional hazard models. The vertical dashed line indicates the cutoff value of 3.40mmol/L. (B) The relationship of prealbumin and MACE incidence based on Cox proportional hazard models. The vertical dashed line indicates the cutoff value of 280mg/L. (C) The relationship of albumin and MACE incidence based on Cox proportional hazard models. The vertical dashed line indicates the cutoff value of 38g/L. The solid red lines were adjusted hazard ratios, with grey red area showing 95% confidence intervals derived from RCS regressions with four knots. Reference lines for no association are indicated by the solid bold lines at a hazard ratio of 1.0. HR: hazard ration; MHD: maintenance hemodialysis; MACE: major adverse cardiovascular event; PEW: protein energy wasting; RCS: restricted cubic spline; TC: total cholesterol.
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References

    1. Collaboration GCKD. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709–733. doi: 10.1016/s0140-6736(20)30045-3. - DOI - PMC - PubMed
    1. Koppe L, Fouque D, Kalantar-Zadeh K.. Kidney cachexia or protein-energy wasting in chronic kidney disease: facts and numbers. J Cachexia Sarcopenia Muscle. 2019;10(3):479–484. doi: 10.1002/jcsm.12421. - DOI - PMC - PubMed
    1. Ikizler TA, Cano NJ, Franch H, et al. . Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013;84(6):1096–1107. doi: 10.1038/ki.2013.147. - DOI - PubMed
    1. Herselman M, Esau N, Kruger JM, et al. . Relationship between serum protein and mortality in adults on long-term hemodialysis: exhaustive review and meta-analysis. Nutrition. 2010;26(1):10–32. doi: 10.1016/j.nut.2009.07.009. - DOI - PubMed
    1. Piccoli GB, Cederholm T, Avesani CM, et al. . Nutritional status and the risk of malnutrition in older adults with chronic kidney disease - implications for low protein intake and nutritional care: a critical review endorsed by ERN-ERA and ESPEN. Clin Nutr. 2023;42(4):443–457. doi: 10.1016/j.clnu.2023.01.018. - DOI - PubMed

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