Study identifies oral nutrition supplement patterns among patients with non-dialysis CKD
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Findings published in the Journal of Renal Nutrition demonstrated the appropriate prescribing method of oral nutrition supplements to patients with non-dialysis chronic kidney disease.
Further, researchers identified nutritional status and nutritional phenotypes among the patient population.
“Previous randomized controlled trials have demonstrated that nutritional supplements can improve nutritional laboratory parameters among dialysis patients. However, there is a paucity of evidence regarding oral nutritional supplements (ONS) use and its effectiveness in the non-dialysis chronic kidney disease (CKD-ND) population,” Michelle M. Y. Wong, MD, MSc, MPH, FRCPC, from the department of medicine at University of British Columbia in Canada, and colleagues wrote. “The aim of this study is to describe baseline nutritional parameters and ONS prescription patterns among CKD-ND patients entering CKD clinics in [British Columbia]. Given the heterogenous nature of [protein-energy wasting], we also sought to identify phenotypes of patients prescribed ONS based on nutritional and inflammatory markers.”
In the observational study, researchers evaluated 15,859 adult patients with CKD-ND who entered multidisciplinary CKD centers in British Columbia between 2013 to 2018. Researchers used descriptive statistics to determine baseline nutrition and inflammation parameters among patients prescribed ONS vs. patients not prescribed ONS within 1 year of entering the center.
Additionally, they applied the hierarchical clustering method with consensus clustering to find phenotypes of patients prescribed ONS. Using multivariable logistic regression, researchers measured the correlation between ONS prescription and health region per 1,000 CKD patients.
Analyses revealed 9% of CKD-ND patients entering CKD centers were prescribed ONS within 1 year of entry. Patients prescribed ONS had lower baseline eGFR, BMI, serum albumin, and bicarbonate and greater age, serum phosphate, and neutrophil-to-lymphocyte ratio than the patients not receiving ONS.
Researchers identified five clusters: “cluster 1 had the highest mean neutrophil-to-lymphocyte ratio; cluster 2 had the lowest mean albumin; cluster 3 had the lowest mean BMI; cluster 4 had the highest mean BMI; and cluster 5 had the lowest mean bicarbonate.”
ONS prescriptions varied regionally, and ONS use among CKD-ND patients remained stable during the 3-year follow-ups.
“In summary, a small proportion of CKD-ND patients do access ONS, and use tends to be short-term, suggesting some ‘reversibility’ for many patients. Improved understanding of the value of regular nutritional assessment, ONS prescription practices and policy discordance will be the focus of future work,” Wong and colleagues wrote. “Future analyses of the association between ONS use and nutritional parameter trajectories and other clinical outcomes in CKD-ND patients will be the focus of future study.”
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