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Abstract：
Malnutrition is a risk factor for disease progression and poor prognosis in chronic kidney disease (CKD). However, the complexity of nutritional status assessment limits its clinical application. This study explored a new method of nutritional assessment in CKD (stage 1-5) patients using the Subjective Global Assessment (SGA) as the gold standard and evaluated its applicability. The kappa test was used to analyze the consistency of the Renal Inpatient Nutrition Screening Tool (Renal iNUT) with SGA and protein-energy wasting. Logistic regression analysis was used to analyze the risk factors of CKD malnutrition and calculate the prediction probability of multiple indicators combined for the diagnosis of CKD malnutrition. The receiver operating characteristic curve of the prediction probability was drawn to evaluate its diagnostic efficiency. A total of 161 CKD patients were included in this study. The prevalence of malnutrition according to SGA was 19.9%. The results showed that Renal iNUT had a moderate consistency with SGA and a general consistency with protein-energy wasting. Age > 60 years (odds ratio, OR = 6.78), neutrophil-lymphocyte ratio > 2.62 (OR = 3.862), transferrin < 200 mg/dL (OR = 4.222), phase angle < 4.5° (OR = 7.478), and body fat percentage < 10% (OR = 19.119) were risk factors for malnutrition in patients with CKD. The area under the receiver operating characteristic curve of multiple indicators for the diagnosis of CKD malnutrition was 0.89 (95% confidence interval: 0.834-0.946, p < 0.001). This study demonstrated that Renal iNUT has good specificity as a new tool for the nutrition screening of CKD patients, but its sensitivity needs to be optimized. Advanced age, high neutrophil-lymphocyte ratio, low transferrin level, low phase angle, and low body fat percentage are risk factors for malnutrition in patients with CKD. The combination of the above indicators has high diagnostic efficiency in the diagnosis of CKD malnutrition, which may be an objective, simple, and reliable method to evaluate the nutritional status of patients with CKD.
摘要：
营养不良是慢性肾脏病（CKD）疾病进展和预后不良的危险因素。然而,营养状况评估的复杂性限制了其临床应用。本研究以主观整体评估（SGA）作为金标准，探索了CKD（1-5期）患者营养评估的新方法，并评估了其适用性。使用kappa检验分析肾脏住院患者营养筛查工具（RenaliNUT）与SGA和蛋白质能量消耗的一致性。采用Logistic回归分析分析CKD营养不良的危险因素,计算多指标联合诊断CKD营养不良的预测概率。绘制了预测概率的接受者工作特性曲线，以评估其诊断效率。共有161名CKD患者被纳入本研究。根据SGA，营养不良的患病率为19.9％。结果表明，肾iNUT与SGA具有中等一致性，与蛋白质能量消耗具有总体一致性。年龄>60岁(赔率比，OR=6.78)，中性粒细胞-淋巴细胞比值>2.62（OR=3.862），转铁蛋白<200mg/dL（OR=4.222），相位角<4.5°（OR=7.478），体脂百分比<10%(OR=19.119)是CKD患者营养不良的危险因素。诊断CKD营养不良的多项指标的受试者工作特征曲线下面积为0.89（95％置信区间：0.834-0.946，p<0.001）。这项研究表明，肾iNUT作为CKD患者营养筛查的新工具具有良好的特异性。但是它的灵敏度需要优化。高龄,高中性粒细胞-淋巴细胞比率，低转铁蛋白水平，低相位角,和低体脂百分比是CKD患者营养不良的危险因素。上述指标的组合在CKD营养不良的诊断中具有较高的诊断效能,这可能是一个目标，简单,评价CKD患者营养状况的可靠方法。
