View PDF versions of the web-only appendices: Subjective
Global Assessment Scoring Sheet, Assessing
the Nutritional Status of Dialysis Patients Using the Subjective Global
Assessment (SGA).
We examined the value of transferrin concentrations in estimating nutritional
status as determined by the subjective global assessment (SGA) score. Fifty-nine
hemodialysis patients (37 men and 22 women, aged 59+/-16 years, dialyzed for
3.6+/-3.9 years) were selected by predetermined criteria. All received
erythropoietin (EPO) and oral iron therapy. SGA evaluation was conducted twice
by both a dietitian and a physician. Serum iron, total iron-binding capacity
(TIBC; which is linearly correlated with transferrin), transferrin saturation
ratio, ferritin, albumin, total protein, and cholesterol were measured. Twenty-
seven (46%) patients were well nourished (group A), 20 (34%) were moderately
nourished (group B), and 12 (20%) were poorly nourished (group C) according to
the SGA. TIBC values were 276+/-47 mg/dL, 217+/- 54 mg/dL, and 176+/-41 mg/dL,
respectively (P < 0.00001), and thus directly correlated with the state of
nutrition. The relationship between TIBC and nutritional status was independent
of age and number of years on hemodialysis. Serum ferritin values were 104+/-93
ng/mL, 161+/-154 ng/mL, and 363+/-305 ng/mL, respectively (P < 0.0003), and
thus inversely correlated with the state of nutrition. Transferrin saturation
ratios were slightly higher in the severely malnourished patients. The number of
years on dialysis were a determinant of nutritional status. These values were
2.4+/-2.4 years for group A, 3.9+/-4.0 years for group B, and 5.7+/-3.9 years
for group C (P < 0.05). The average age of the poorly nourished patients was
10 years older than the well-nourished patients. Serum iron values were lower
but transferrin saturation ratios were higher in the severely malnourished
patients. The required EPO doses were higher in the poorly nourished patients.
We suggest that transferrin values are superior to other laboratory tests in
assessing nutrition and will supplement SGA criteria. Serum ferritin may be
useful as a predictor of illness. Older patients who have been on dialysis
longer warrant special concern. Malnutrition may be an indicator of EPO
resistance in dialysis patients. Finally, since a decreased TIBC level in poorly
nourished patients may erroneously increase the transferrin saturation ratio,
our findings may have implications in making the diagnosis and treatment of
anemia and iron deficiency in malnourished dialysis patients.
(Am J Kidney
Dis 1998 Feb;31(2):263-72)
