Potential Determinants of Subjective Global Assessment Among Patients on Maintenance Hemodialysis

The Subjective Global Assessment (SGA) is a validated tool for identifying nutritional status in patients receiving maintenance hemodialysis (MHD), but it is not without limitations. Current research identifies additional clinical characteristics such as phase angle (PhA) associated with SGA. This study aimed to assess the overall correlation between PhA and SGA; associations between PhA and SGA by body mass index, and to identify clinical characteristics associated with SGA.

This is a secondary analysis of the Rutgers Nutrition & Kidney Database, which enrolled participants from four primary studies that included adults diagnosed with chronic kidney disease who were receiving MHD. Multivariable binary logistic regression analyses were conducted to estimate odds ratio (OR) and corresponding 95% confidence intervals (CIs).

The study sample included 60.0% males with 81.1% of the sample identifying as African American. Additionally, 38.9% were obese according to the body mass index classification, and 57.0% were moderately malnourished. Patients with obesity had 44% lower odds of being moderately malnourished (OR = 0.56, 95% CI = 0.37, 0.85). In the model adjusted for age and ethnicity and other clinical characteristics, increasing PhA values by one unit was associated with 28% lower odds (OR = 0.72, 95% CI = 0.53, 0.97) of being moderately malnourished while increasing waist circumference (WC) values by one unit was associated with 12% higher odds (OR = 1.12; 95% CI = 1.06, 1.19) of being moderately malnourished than well-nourished. In this fully adjusted model, increasing fat free mass (FFM, OR = 0.95, 95% CI = 0.91, 0.99) and fat mass (FM, OR = 0.92, 95% CI = 0.87, 0.97) by 1 kg was also associated with 5% and 8% lower odds of being moderately malnourished, respectively.

PhA and SGA were significantly associated only among patients classified as obese. PhA, WC, FM, and FFM were identified as potential clinical determinants of SGA. Patients receiving MHD and who have obesity may benefit from utilizing SGA along with WC, PhA, FM, and FFM to assess nutritional status.