Subjective global assessment of nutrition, dialysis quality, and the theory of the scientific method in Nephrology practice.

Autor: Zsom L; Cegléd Dialysis Unit, Fresenius Medical Care, Cegléd, Hungary., Zsom M; Department of Medicine, Szent Rókus Hospital, Baja, Hungary., Abdul Salim S; Department of Medicine, Nephrology Division, University of Mississippi Medical Center, Jackson, MS, USA., Fülöp T; Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA.; Department of Medicine, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
Jazyk: angličtina
Zdroj: Artificial organs [Artif Organs] 2020 Oct; Vol. 44 (10), pp. 1021-1030. Date of Electronic Publication: 2020 Jul 27.
DOI: 10.1111/aor.13762
Abstrakt: In an era of evidence-based medicine and dialysis performance measures, there is strong motivation to find specific, objective, quantifiable, and reproducible parameters to characterize the clinical condition of chronic kidney disease patients and to present population-wide statistics that may describe quality of care in dialysis centers. Yet, in the last three decades, several studies demonstrated that while parameters including Kt/V urea, serum phosphorus, parathyroid hormone, serum cholesterol fulfill all these criteria, efforts to optimize these lab parameters failed to improve survival on dialysis. However, subjective assessments of nutrition including subjective global assessment and malnutrition-inflammation score, while not ideally suited for statistical analysis and not optimal from the point of view of scientific methodology due to their general, semi-quantifiable, subjective nature have, nevertheless, proved themselves as some of the strongest predictors of clinical outcomes in the dialysis population. Where does this paradox leave us? We propose that a deeper understanding of relevance of these variables in the dialysis population may improve appreciation of the clinical situation of individual patients and may result in a paradigm shift from dialysis adequacy to quality dialysis.
(© 2020 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.)
Databáze: MEDLINE
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