Simplified Subjective Global Assessment at Hemodialysis Initiation and Its Association with 2-Year Mortality and Hospitalization

INTRODUCTION: Nutritional risk assessment, which is necessary for initiating appropriate nutritional therapy to improve prognosis, should be as simple as possible to perform, particularly when direct patient contact is limited. We examined whether simplified Subjective Global Assessment (SGA), a modified SGA method omitting physical examination components, is associated with prognosis in patients with kidney failure starting hemodialysis (HD). METHODS: Retrospectively, we reviewed the medical records of patients who initiated HD between 2016 and 2018. Based on these records, two dialysis nurses independently assessed each patient's nutritional status using simplified SGA and categorized them as well-nourished (W) or malnourished (M). Patients were classified into three groups (W-W, W-M, and M-M) according to the combination of the two assessments. The primary composite outcome was death or hospitalization within two years. RESULTS: A total of 138 patients starting HD (mean age 66.8 years; 70% male) were examined. According to simplified SGA, 97 (70%), 25 (18%), and 16 (12%) patients were categorized respectively as W-W, W-M, and M-M. Kaplan-Meier analysis showed significantly lower survival and hospitalization-free rates in the M-M group (p < .001 and = .024, respectively). Cox proportional hazards analysis demonstrated significant association between the M-M category and the primary outcome (hazard ratio 3.34, 95% confidence interval 1.52-7.36). CONCLUSION: Simplified SGA scores might be associated with 2-year adverse outcomes in patients starting HD.