The Impact of PG-SGA-Based Individualized Nutritional Intervention on Nutritional Status, Phosphorus Management, and Uremic Pruritus in Hemodialysis Patients​​

 

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The Impact of PG-SGA-Based Individualized Nutritional Intervention on Nutritional Status, Phosphorus Management, and Uremic Pruritus in Hemodialysis Patients​​

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Xintong
Han
Xintong Han 2672595112@qq.com ​​The First Hospital of Jilin University​​ Blood Purification Center JilinChangchun China *
Liting He 2672595112@qq.com The First Hospital of Jilin University​​ Blood Purification Center JilinChangchun China -
Hui Zhong 2672595112@qq.com The First Hospital of Jilin University​​ Blood Purification Center JilinChangchun China -
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To evaluate the comprehensive clinical effects of a precision nutritional intervention protocol developed based on the Patient-Generated Subjective Global Assessment (PG-SGA) in maintenance hemodialysis (MHD) patients. This study aims to verify the efficacy and superiority of this strategy in improving protein-energy wasting (PEW), regulating calcium-phosphorus metabolism disorders (CKD-MBD), and alleviating uremic pruritus.

This multicenter, prospective, controlled study enrolled 648 regularly dialyzed patients from multiple blood purification centers between February 2023 and March 2025. Participants were randomly assigned in a 1:1 ratio to the intervention group (n=324) or control group (n=324). The control group received standard dialysis care and conventional dietary education. The intervention group underwent multidimensional, PG-SGA-centered individualized nutrition management:Implementation:Led by senior clinical dietitians, with dynamic nutritional risk stratification based on PG-SGA scores.Interventions:Personalized dietary prescriptions (precise protein/calorie intake per kg body weight, with focused guidance on low-phosphorus diet techniques and food selection).Prescription oral nutritional supplements (ONS) for moderate-to-severe malnutrition cases.Monthly follow-ups and protocol adjustments.Duration:6-month intervention period.Primary Outcomes:Nutritional biomarkers (serum albumin, prealbumin, hemoglobin), mineral metabolism parameters (blood phosphorus, calcium, iPTH), and pruritus Visual Analog Scale (VAS) scores. Statistical analyses included repeated-measures ANOVA and chi-square tests.

Significant intergroup differences were observed post-intervention:Nutritional Status:​​Intervention group showed superior improvements in serum albumin (35.2±3.1 39.8±2.5 g/L) and prealbumin (280±45 325±40 mg/L) vs. controls (P<0.01), with PEW incidence decreasing from 31.7% to 11.7% (P<0.05).Phosphorus Management:​​Blood phosphorus levels effectively controlled (2.25±0.41 1.78±0.35 mmol/L), with phosphorus target achievement rate (<1.78 mmol/L) rising from 18.3% to 58.3% (significantly higher than controls' 25.0%, P<0.01). No intergroup differences in iPTH or calcium.Pruritus Symptoms:​​VAS scores median dropped from 6.5 to 2.0 points (greater improvement vs. controls, P<0.01), with significant subjective quality-of-life enhancements.

PG-SGA-based individualized nutrition intervention is a systematic, precision-based management strategy that:Significantly reverses MHD patients' malnutrition, Achieves superior phosphorus control versus conventional methods, and Demonstrates marked synergistic relief for uremic pruritus. This study provides high-level evidence supporting structured nutritional support as a core pillar of MHD comprehensive care, with significant clinical implications for improving long-term outcomes and quality of life.

Kewords