More prescriptions a patient has linked with poor nutritional status in those with CKD
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Among patients with chronic kidney disease, the more medication prescriptions one has is associated with poor nutritional status, according to data published in the Journal of Renal Nutrition.
Further, researchers recommend monitoring nutritional status in patients with CKD with long medication lists as a way to prepare for, identify and treat those with poor status.
“As the kidney function declines, dietary intake and metabolism of nutrients will be affected, increasing the occurrence and severity of poor nutritional status. These may include both obesity and undernutrition, as well as changes in nutrient metabolism,” Helene Dahl, MS, RD, from the department of clinical medicine at the University of Bergen in Norway, and colleagues wrote. They added, “To our knowledge, the association between nutritional status and the number of prescribed medications or their nutritional-related side-effects has not yet been investigated in patients with CKD.”
In a cross-sectional study, researchers observed 217 patients with CKD, 112 of whom had pre-dialysis CKD stages three to five, 33 were on hemodialysis and 72 had kidney transplants. Researchers collected patients’ prescribed medication information from electronic records and grouped medications according to the nutrition-related adverse events of xerostomia and nausea. They then identified the nutritional status of each patient using anthropometric measurements of height, weight, BMI, mid-upper arm circumference, skinfold thickness triceps and waist circumference.
For data analyses, patients were grouped based on their current treatment of CKD (pre-dialysis, dialysis or transplant) on their CKD stage defined by eGFR and, finally, on their prescribed medication with the nutrition-related adverse events of xerostomia and nausea. Using linear regression analyses adjusting for age, sex and eGFR, researchers determined the correlation between the number of prescribed medications and the different measurements of nutritional status.
The average number of medications prescribed to individual patients was nine. Consequently, the number of prescribed medications was inversely associated with mid-upper arm circumference, skinfold thickness triceps, handgrip strength, serum albumin, and hemoglobin after adjustment for age, sex and kidney function. Medications with nausea listed as an adverse event yielded similar results, while medications with xerostomia as an adverse event correlated with less handgrip strength.
According to the study, “The main findings are a high prevalence of polypharmacy and excessive polypharmacy (84% and 37%, respectively), a high prevalence of overweight and obesity (62%) but a low prevalence of underweight (1.4%).”
Researchers noted that a limitation of the study the use of records to measure prescribed medications rather than monitoring actual intake.
“In this study, patients with a high number of prescribed medications were at risk of a poor nutritional status. The association was especially evident by a comprehensive assessment, including factors beyond height, weight and BMI. In particular, nutritional status was poor in patients who had been prescribed medications with common or very common side-effects of nausea, accounting for 66% of patients in our population,” Dahl and colleagues wrote. “These findings suggest that special attention should be paid to the nutritional status of patients with CKD with long medication lists. A wider assessment of nutritional status including measurements such as [mid-upper arm circumference] MUAC, [skin fold thickness] SFT triceps and [handgrip strength] HGS should be conducted regularly to identify potential challenges of nutritional status and address these accordingly in patients with CKD.”
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