The 54 participating RDs were trained to perform SGA and collect data via a website created for this study. Interrater reliability for SGA was tested in a subset of 76 patients, via an SGA performed by a second RD at baseline, while intrarater reliability was assessed by the original RD repeating the SGA at 1 month. Data collection occurred at HD facilities in the United States (109 patients), Canada (35 patients), and New Zealand (9 patients).
Of the 153 patients, 46 % were female, 64 % were Caucasian, 6 % were Hispanic, 21 % were African American, and 6 % were Asian. The primary etiologies were hypertension (33 % ), type 2 diabetes mellitus (DM) (27 % ), type 1 DM (10 % ), and glomerular nephritis (10 % ); 59 % had cardiovascular disease. The mean age, body mass index (BMI), serum albumin, and duration on HD were 64 ¡À 14 years (mean ¡À SD), 28 ¡À 7 kg/m2, 3.7 ¡À 0.4 mg/dL, and 41 ¡À 34 months, respectively. SGA scores were well nourished (7)?0 % ; mildly malnourished (MN 6)?1 % ; moderately MN 5?1 % , 4? % , and 3? % ; and severely MN (2 and 1)? % . SGA training via the Internet achieved fair interrater reliability (weighted Kappa = 0.5, Spearman¡¯s Rho = 0.7) and substantial intrarater reliability (weighted Kappa = 0.7, Spearman¡¯s Rho = 0.8) (P < .001). Validity was demonstrated through statistically significant differences in mean BMI and serum albumin across the 5 categories of SGA (7?8 ¡À 7, 6?9 ¡À 7, 5?8 ¡À 8, 4?1 ¡À 4, 3?4 ¡À 2, P < .05; and 7?.8 ¡À 0.3, 6?.8 ¡À 0.4, 5?7 ¡À 0.05, 4?.4 ¡À 0.07, 3?.9 ¡À 1.2, P < .001, respectively). Nutritional status varied by age (P < .05), but not ethnicity or nationality.
We conclude that the 7-point scale SGA is a reliable and valid tool for nutritional assessment in adults on HD.