Protein-Energy Wasting Among Patients With Nondialysis Chronic Kidney Disease: Comparing ISRNM and GLIM Criteria With...

Protein-energy wasting (PEW) is a critical complication among patients with chronic kidney disease (CKD). The International Society of Renal Nutrition and Metabolism (ISRNM) and Global Leadership Initiative on Malnutrition (GLIM) criteria have been proposed for PEW diagnosis, yet their accuracy and prognostic relevance in nondialysis CKD populations remain underexplored.

In a prospective cohort of 156 nondialysis patients with CKD stages 3-5, PEW was assessed using the ISRNM, GLIM criteria, and the PEW score, with Malnutrition-Inflammation Score (MIS) (cutoff ≥ 5) serving as the reference standard. Diagnostic performance was determined by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Prognostic significance was examined using Cox models for a composite outcome of end-stage kidney disease or all-cause mortality.

Participants had a median age of 66.0 years, 41% were women, and 38% had diabetes. PEW was identified in 33 patients (21.2%) by MIS, 24 (15.4%) by ISRNM, and 22 (14.1%) by GLIM. Compared to the MIS, the ISRNM criteria exhibited low sensitivity (30.3%) but high specificity (88.6%), with a PPV of 41.7% and NPV of 82.6%. The GLIM criteria yielded similar metrics. In contrast, the PEW score showed higher sensitivity (75.8%) but lower specificity (50.4%), with a PPV of 29.1% and an NPV of 88.6%. Furthermore, MIS-defined PEW was associated with increased risk of end-stage kidney disease or death (adjusted hazard ratio 1.92; 95% confidence interval, 1.04-3.52; P = .036), whereas PEW defined by ISRNM, GLIM, or the PEW score was not.

The ISRNM and GLIM criteria show limited utility as screening tools for PEW due to poor sensitivity in nondialysis CKD populations. Although the PEW score demonstrates higher sensitivity, its diagnostic specificity is suboptimal. The MIS offers superior prognostic discrimination and may serve as a more appropriate reference for future PEW diagnostic frameworks.