P185
SUBJECTIVE GLOBAL ASSESSMENT IS AN INDEPENDENT PREDICTOR OF
CARDIAC ISCHAEMIA IN PATIENTS WITH MILD CKD
Aldous, G1, Sharma, R2, O’Driscoll, J3, Ashby, D1, Tam, F1, Choi, P1
1
Imperial College Kidney and Transplant Institute, Imperial College NHS Trust, London
2
Ealing Hospital NHS Trust, Cardiology, Ealing Hospital, London, 3Thames Valley
University, Faculty of Health and Human Sciences, London,
BACKGROUND: Patients with chronic kidney disease (CKD) have high mortality rates due to
increased incidence of cardiovascular disease. Studies of dialysis patients have shown that
cardiovascular disease and death may be predicted by poor nutritional status up to 10 years in
advance. There have been no studies of cardiac parameters and nutritional status in patients with
mild chronic kidney disease.
METHODS: We performed a cross-sectional analysis of the nutritional status of 80 consecutive
patients undergoing dobutamine stress echocardiography, assessed by a single blinded operator. We
performed a 7 point Subjective Global Assessment (SGA) of each patient. We compared the cardiac
status of patients with SGA scores ≤5 and those with SGA score 6-7. Differences in continuous
variables were analysed by unpaired T-test. Categorical variables were assessed using Chi-Square
test. Logistic regression was performed using SPSS v16.0.
RESULTS : Twenty (25%) patients demonstrated an SGA score ≤5. SGA score ≤5 was associated
with lower mean body mass index (25.7 v 31.0 kg/m2, p=0.001) and serum albumin (43.2 v
45.4g/L, p=0.005). There were no significant differences in the mean of age (68.2yrs), gender
(56.2% male), MDRD eGFR (78.7mls/min/1.73m2, range 11-165), prevalence of diabetes mellitus
(28.8%), haemoglobin (13.3g/L) or C-reactive protein (5.3mg/L) between patients with SGA score
≤5 or 6-7. Patients with an SGA score ≤5 demonstrated a significantly higher rate of ischaemia, as
defined by a deterioration in wall motion score in one or more left ventricular segments (55% v
12%, p<0.001), and reduced ability to augment ejection fraction at peak stress (∆EF 11.2% v
14.6%, p=0.03). There were no differences in baseline EF (56.9% v 59.9%) or left ventricular enddiastolic (4.8 v 4.6cm) and end-systolic diameter (2.8 v 2.6cm). Step-wise logistic regression
identified SGA score ≤5 (OR 12.2, p<0.001) and eGFR (OR 0.96/ml/min/1.73m2, p=0.01) as
independent predictors of ischaemia. Linear regression also identified SGA score ≤5 (p=0.001) and
eGFR (p=0.019) as independent predictors of ∆EF.
CONCLUSION: Patients with lower SGA scores are more likely to exhibit cardiac ischaemia. This
may be one pathophysiological mechanism to explain the poor cardiovascular outcomes associated
with protein energy wasting in renal patients.