External validation of a novel nomogram for diagnosis of Protein Energy Wasting in adult hemodialysis patients

Danying Yan; Yi Wang; Jing Hu; Renhua Lu; Chaoyang Ye; Nanmei Liu; Dongping Chen; Weiwei Liang; Liang Zheng; Wenrui Liu; Tianying Lan; Naiying Lan; Qing Shao; Shougang Zhuang; Xiaoyan Ma; Na Liu

doi:10.3389/fnut.2024.1351503

External validation of a novel nomogram for diagnosis of Protein Energy Wasting in adult hemodialysis patients

Front Nutr. 2024 Aug 13:11:1351503. doi: 10.3389/fnut.2024.1351503. eCollection 2024.

Authors

Danying Yan^#¹, Yi Wang^#¹, Jing Hu², Renhua Lu³, Chaoyang Ye⁴, Nanmei Liu⁵, Dongping Chen⁴, Weiwei Liang¹, Liang Zheng⁶, Wenrui Liu², Tianying Lan⁴, Naiying Lan⁵, Qing Shao⁵, Shougang Zhuang^{1

7}, Xiaoyan Ma¹, Na Liu¹

Affiliations

¹ Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Nephrology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³ Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
⁴ Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
⁵ International Medicine III (Nephrology & Endocrinology), Naval Medical Center of People's Liberation Army of China, Naval Medical University, Shanghai, China.
⁶ Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
⁷ Department of Medicine, Rhode Island Hospital and Alpert Medical School, Brown University, Providence, RI, United States.

^# Contributed equally.

Abstract

Background: Protein Energy Wasting (PEW) has high incidence in adult hemodialysis patients and refers to a state of decreased protein and energy substance. It has been demonstrated that PEW highly affects the quality of survival and increases the risk of death. Nevertheless, its diagnostic criteria are complex in clinic. To simplify the diagnosis method of PEW in adult hemodialysis patients, we previously established a novel clinical prediction model that was well-validated internally using bootstrapping. In this multicenter cross-sectional study, we aimed to externally validate this nomogram in a new cohort of adult hemodialysis patients.

Methods: The novel prediction model was built by combining four independent variables with part of the International Society of Renal Nutrition and Metabolism (ISRNM) diagnostic criteria including albumin, total cholesterol, and body mass index (BMI). We evaluated the performance of the new model using discrimination (Concordance Index), calibration plots, and Clinical Impact Curve to assess its predictive utility.

Results: From September 1st, 2022 to August 31st, 2023, 1,158 patients were screened in five medical centers in Shanghai. 622 (53.7%) hemodialysis patients were included for analysis. The PEW predictive model was acceptable discrimination with the area under the curve of 0.777 (95% CI 0.741-0.814). Additionally, the model revealed well-fitted calibration curves. The McNemar test showed the novel model had similar diagnostic efficacy with the gold standard diagnostic method (p > 0.05).

Conclusion: Our results from this cross-sectional external validation study further demonstrate that the novel model is a valid tool to identify PEW in adult hemodialysis patients effectively.

Keywords: Protein Energy Wasting; diagnosis; external validation; hemodialysis; prediction model.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Pudong foundation for development of science and technology (PKJ2022-Y56), the National Nature Science Foundation of China grants (82070791), the Shanghai Scientific Committee of China (23ZR1452200), the Shanghai Municipal Health Committee of China (202340001), the Shanghai Pudong New Area summit (emergency medicine and critical care) construction project (PWYgf2021-03), the Key Discipline Construction Project of Shanghai Pudong New Area Health Commission (PWZxk2022-05), the Project of Pudong Health Bureau of Shanghai (PW2021D-04), the Outstanding Leaders Training Program of Pudong Health Bureau of Shanghai (PWR12021-02), the Shanghai Health Bureau and Shanghai administration of traditional Chinese Medicine of China (ZHYY-ZXYJHZX-202114) and the clinical investigation grant of Shanghai East Hospital (DFLC2022016).