Karin Windahl1, Gerd Faxén Irving2, Tora Almquist3, Maarit Korkeila Lidén4, Peter Stenvinkel4, Nicholas C Chesnaye5, Christiane Drechsler6, Maciej Szymczak7, Magdalena Krajewska7, Edouard L Fu8, Claudia Torino9, Gaetana Porto9, Paul Roderick10, Fergus J Caskey11, Christoph Wanner6, Friedo W Dekker8, Kitty J Jager5, Marie Evans4. 1. Renal unit, Department of clinical intervention and technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Division of Clinical Nutrition and Dietetics, Department of Orthopedics, Danderyds Hospital, Stockholm, Sweden. Electronic address: Karin.windahl@ki.se. 2. Division of Clinical Geriatrics, Department of NVS, Karolinska Institutet, Stockholm, Sweden. 3. Division of Nephrology, Department of Clinical Sciences, Danderyds Hospital, Stockholm, Sweden. 4. Renal unit, Department of clinical intervention and technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. 5. ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research Institute, Amsterdam, the Netherlands. 6. Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany. 7. Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland. 8. Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands. 9. 4CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy. 10. Department of renal medicine, North Bristol NHS Trust, Bristol, UK. 11. Department of renal medicine, North Bristol NHS Trust, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK.
Abstract
OBJECTIVE: The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease. DESIGN AND METHODS: The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observational cohort study involving six European countries. We included 1,103 adults >65 years with incident estimated glomerular filtration rate <20 mL/min/1.73 m2 not on dialysis, attending nephrology care. Nutritional status was assessed with the 7-point Subjective Global Assessment tool (7-p SGA), patient-reported outcomes with RAND-36 and the Dialysis Symptom Index. Logistic regression was used to estimate the associations between potential risk factors and SGA decline. RESULTS: The majority of the patients had a normal nutritional status at baseline, 28% were moderately malnourished (SGA ≤5). Overall, mean SGA decreased by -0.18 points/year, (95% confidence interval -0.21; -0.14). More than one-third of the study participants (34.9%) deteriorated in nutritional status (1 point decline in SGA) and 10.9% had a severe decline in SGA (≥2 points). The proportion of patients with low SGA (≤5) increased every 6 months. Those who dropped in SGA also declined in estimated glomerular filtration rate and mental health score. Every 10 points decrease in physical function score increased the odds of decline in SGA by 23%. Lower physical function score at baseline, gastrointestinal symptoms, and smoking were risk factors for impaired nutritional status. There was an interaction between diabetes and physical function on SGA decline. CONCLUSIONS: Nutritional status deteriorated in more than one-third of the study participants during the first year of follow-up. Lower patient-reported physical function, more gastrointestinal symptoms, and current smoking were associated with decline in nutritional status.
OBJECTIVE: The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease. DESIGN AND METHODS: The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observational cohort study involving six European countries. We included 1,103 adults >65 years with incident estimated glomerular filtration rate <20 mL/min/1.73 m2 not on dialysis, attending nephrology care. Nutritional status was assessed with the 7-point Subjective Global Assessment tool (7-p SGA), patient-reported outcomes with RAND-36 and the Dialysis Symptom Index. Logistic regression was used to estimate the associations between potential risk factors and SGA decline. RESULTS: The majority of the patients had a normal nutritional status at baseline, 28% were moderately malnourished (SGA ≤5). Overall, mean SGA decreased by -0.18 points/year, (95% confidence interval -0.21; -0.14). More than one-third of the study participants (34.9%) deteriorated in nutritional status (1 point decline in SGA) and 10.9% had a severe decline in SGA (≥2 points). The proportion of patients with low SGA (≤5) increased every 6 months. Those who dropped in SGA also declined in estimated glomerular filtration rate and mental health score. Every 10 points decrease in physical function score increased the odds of decline in SGA by 23%. Lower physical function score at baseline, gastrointestinal symptoms, and smoking were risk factors for impaired nutritional status. There was an interaction between diabetes and physical function on SGA decline. CONCLUSIONS: Nutritional status deteriorated in more than one-third of the study participants during the first year of follow-up. Lower patient-reported physical function, more gastrointestinal symptoms, and current smoking were associated with decline in nutritional status.