Prognostic significance of controlling nutritional status (CONUT) score in hemodialysis patients

Year 2022, Volume: 4 Issue: 2, 197 - 201, 29.03.2022

Fatma Yılmaz Aydın , Enver Yüksel , Emre Aydın

https://doi.org/10.38053/acmj.1076364

Abstract

Introduction: Malnutrition is a common and important problem in HD Hemodialysis (HD) patients. Malnutrition occurs due to various factors increases the risk of morbidity and mortality in HD patients. The Controlling Nutritional Status (CONUT) score has been designed to assess the nutritional status in patients. In addition, the relationship between the CONUT score and mortality has been investigated. We aimed to investigate the effectiveness of the CONUT score in predicting mortality in HD patients.
Material and Method: The data of 110 patients who started HD between 2017-2021 were analyzed retrospectively. From the laboratory parameters were evaluated before starting the first hemodialysis treatment. The CONUT score was calculated based on lymphocyte count, total cholesterol levels, and serum albumin levels. The patients were divided into two groups as CONUT score ≤4 and CONUT score ≥5. The groups were compared regarding these parameters.
Results: The data of 110 hemodialysis patients were analyzed. 58 (52.7%) of these patients were male. The mean age of the patients was 53.18±17.10 years. There were 49 (44.5%) patients with a CONUT score of ≤4 and 61 (55.5%) patients with a CONUT score of ≥5. 35 patients (13.9%) died. Among 35 all-cause deaths, 4 (11.4%) were occurred in the low CONUT group, and 31 (88.6%) were occurred in the high CONUT group (p<0.001). According to Kaplan-Meier analysis, the high CONUT group had significantly higher all-cause mortality (p<0.001) than the low CONUT group. According to the correlation analysis, there was a positive correlation between the CONUT score and mortality (p<0.001). In the multivariate Cox regression analysis, all cause of mortality was independently correlated to age, gender (male) and CONUT score (p: 0.010, p: 0.038 and p < 0.001, respectively). According to the ROC curve analysis, the optimal cut-off value of CONUT score in Hemodialysis HD patients was found at 4.5.
Conclusion: We concluded that the higher the CONUT score, the worse the nutritional status in hemodialysis patients, and may be associated with worse clinical outcomes. It is extremely important to evaluate the nutritional status at regular intervals, to detect malnutrition early and to follow up the results in HD patients. We think that CONUT score can be useful in predicting mortality risk for HD patients in clinical practice.

Keywords

Malnutrition, Hemodialysis, Mortality, CONUT score

Supporting Institution

No

Project Number

No

Thanks

The authors would like to thank everyone who contributed to the completion of this study.

References

• Sahathevan S, Khor BH, Ng HM, et al. Understanding development of malnutrition in hemodialysis patients: a narrative review. Nutrients 2020; 12: 3147.
• Altıparmak MR. Nutrition in Hemodialysis. Turkiye Klinikleri J Nephrol-Special Topics 2015; 8: 53-60.
• Yuksel E, Aydin E. The relationship between serum vitamin D levels and health-related quality of life in peritoneal dialysis patients. Int Urol Nephrol 2021 Jul 22. doi: 10.1007/s11255-021-02951-2.
• Ikizler TA, Burrowes JD, Byham-Gray LD, et al. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis 2020; 76: S1-S107.
• Yang Y, Zhou H, Zhang P, Chao W, Zou Y, Yang M. Evaluation of objective nutritional indexes as predictors of worse outcomes in peritoneal dialysis patients. Nutrition 2020; 79-80: 110963.
• Mineoka Y, Ishii M, Hashimoto Y, Nakamura N, Fukui M. Malnutrition assessed by controlling nutritional status is correlated to carotid atherosclerosis in patients with type 2 diabetes. Endocr J 2019; 66: 1073-82.
• Spoletini G, Ferri F, Mauro A, et al. CONUT score predicts early morbidity after liver transplantation: a collaborative study. Front Nutr 2022; 8: 793885.
• Cohen SD, Kimmel PL. Nutritional status, psychological issues and survival in hemodialysis patients. Contrib Nephrol 2007; 155: 1-17.
• Kokura Y, Kimoto K, Okada Y, Kawakita S. The Controlling Nutritional Status score as a functional prognostic marker in patients with acute stroke: a multicenter retrospective cohort study. Nutrition 2020; 110889: 79-80.
• Yang Y, Xu Y, Zhang P, Zhou H, Yang M, Xiang L. Predictive value of objective nutritional indexes in technique failure in peritoneal dialysis patients. J Ren Nutr 2021: S1051-2276(21)00232-6.
• Reddan DN, Klassen PS, Szczech LA, et al. White blood cells as a novel mortality predictor in haemodialysis patients. Nephrol Dial Transplant 2003; 18: 1167-73.
• Obialo CI, Okonofua EC, Nzerue MC, Tayade AS, Riley LJ. Role of hypoalbuminemia and hypocholesterolemia as copredictors of mortality in acute renal failure. Kidney Int. 1999; 56: 1058-63.
• Dwyer JT, Larive B, Leung J, et al. HEMO Study Group. Are nutritional status indicators associated with mortality in the Hemodialysis (HEMO) Study? Kidney Int 2005; 68: 1766-76.
• Takagi K, Buettner S, Ijzermans JNM, Wijnhoven BPL. Systematic review on the controlling nutritional status (CONUT) score in patients undergoing esophagectomy for esophageal cancer. Anticancer Res 2020; 40: 5343-9.
• Peng L, Meng C, Li J, et al. The prognostic significance of controlling nutritional status (CONUT) score for surgically treated renal cell cancer and upper urinary tract urothelial cancer: a systematic review and meta-analysis. Eur J Clin Nutr 2021 Nov 23. doi: 10.1038/s41430-021-01014-0.
• Kheirouri S, Alizadeh M. Prognostic potential of the preoperative controlling nutritional status (CONUT) score in predicting survival of patients with cancer: a systematic review. Adv Nutr 2021; 12: 234-50.
• Baysal M, Bas V, Demirci U, et al. The utility of CONUT score in diffuse large B cell lymphoma patients. Niger J Clin Pract 2021; 24: 1194-9.
• Kamiya T, Ito C, Fujita Y, et al. The prognostic value of the controlling nutritional status score in patients with multiple myeloma. Leuk Lymphoma 2020; 61: 1894-900.
• Akgun Cagliyan G. Is CONUT score a predictor of morbidity in patients with adult transfusion dependent beta thalassemia? Transfus Apher Sci 2021; 60: 103126.
• Kato T, Yaku H, Morimoto T, et al. Association with controlling nutritional status (CONUT) score and in-hospital mortality and infection in acute heart failure. Sci Rep 2020; 10: 3320.
• Wei X, Chen H, You Z, et al. Nutritional status and risk of contrast-associated acute kidney injury in elderly patients undergoing percutaneous coronary intervention. Clin Exp Nephrol 2021; 25: 953-62.
• Ahn SS, Jung SM, Song JJ, Park YB, Lee SW. Controlling nutritional status score is associated with all-cause mortality in patients with antineutrophil cytoplasmic antibody-associated vasculitis. Yonsei Med J 2019; 60: 1164-73.
• Sun X, Luo L, Zhao X, et al. Controlling Nutritional Status (CONUT) score as a predictor of all-cause mortality in elderly hypertensive patients: a prospective follow-up study. BMJ Open 2017; 7: e015649.
• Zhou H, Chao W, Cui L, Li M, Zou Y, Yang M. Controlling Nutritional Status (CONUT) score as immune-nutritional predictor of outcomes in patients undergoing peritoneal dialysis. Clin Nutr 2020; 39: 2564-70.