Study: 35% of patients with advanced CKD saw decline in nutritional status before dialysis
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Nearly 35% of patients with advanced chronic kidney disease experienced a deterioration in nutritional status in the course of a year, according to research conducted across six European countries.
Investigators linked specific patient-reported measures and lifestyle factors — including physical function, smoking and gastrointestinal symptoms — to an increased risk.
“These findings could guide health professionals toward a personalized approach,” Karin Windahl, RD, MSc, of the renal unit in the department of clinical intervention and technology at Karolinska Institutet in Stockholm, and colleagues wrote.
For the study, Windahl and colleagues included 1,103 patients with CKD stages 4 to 5 who had repeated measurements of the seven-point subjective global assessment (SGA).
“SGA is composed of four domains; history of weight change, history of dietary intake and gastrointestinal symptoms, a physical examination with visual inspection to screen for loss of fat mass and muscle wasting,” the researchers wrote. “ ... We defined a decline in nutritional status as at least one point decline in SGA at any visit during the first 12 months of follow-up. A severe decline in nutritional status was defined as a decline of two or more points during the first 12 months of follow-up.”
All patients were at least 65 years and resided in Germany, Italy, the Netherlands, Poland, Sweden or the United Kingdom; 28% were “moderately malnourished” at baseline (defined as having an SGA of 5 or less) and 24% initiated treatment with dialysis during a mean follow-up of 1.6 years.
Worse nutritional status
At 1 year of follow-up, researchers identified impaired nutritional status in 34.9% of the study population, with a severe decline in SGA occurring in 10.9%. During the entire follow-up period (up to 4 years), the mean SGA change was -0.18 points per year.
Findings indicated that the proportion of patients with lower SGA scores increased every 6 months, while the proportion of patients with SGA scores of 6 or 7 decreased.
Windahl and colleagues identified an association between decline in SGA and a greater reduction in eGFR (mean change of 2 mL/min/1.73 m2 vs. -0.7 mL/min/1.73 m2 for those whose nutritional status remained stable throughout the study period).
Potential modifiable factors
Further results suggested that current smoking served as a “strong risk factor” for worsening nutritional status (odds ratio = 2.64) and that mental health may have an impact, as patients who had stable mental component summary score (MCS) also had stable nutritional status while those who saw a decline in MCS experienced a drop in nutritional status.
“The cause and effect of these relationships may be difficult to disentangle in this observational study,” the researchers wrote of this finding. “However, if the associations are bidirectional, one could speculate on their relationships. Fatigue and lack of motivation may contribute to a poor diet and a worse nutritional status, while a deteriorated nutritional status could influence the mental health and health behavior.”
Regarding physical status, researchers observed that every 10 points lower physical component summary score led to a 23% increased odds for SGA decline.
Constipation and decreased appetite also showed significant associations with deterioration in nutritional status.
“Patient-reported measures influence the course of nutritional status in elderly people with CKD stage 4 [to] 5, not yet on dialysis,” Windahl and colleagues concluded. “ ... Future studies should explore if specific interventions guided toward the risk groups will reduce the risk of SGA decline.”
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