Nutritional status, mortality and kidney disease progression in older patients with advanced chronic kidney disease.

BACKGROUND & AIMS: Malnutrition is common in older patients with advanced chronic kidney disease (CKD). This study investigates whether nutritional status is associated with 1-year mortality and CKD progression in this population.

METHODS

Patients ≥65 years (eGFR 20-10 mL/min/1.73 m2) were included from the observational prospective DIALOGICA study. Patients were classified as being at risk of malnutrition with a Mini Nutritional Assessment Short-Form (MNA-SF) score ≤11 and as having a normal nutritional status with scores ≥12. One-year mortality was defined as death (all-cause) occurring within 1-year and CKD progression as eGFR decline <10 mL/min/1.73 m2 and/or initiation of kidney replacement therapy (KRT) within 1-year from inclusion. Associations between nutritional status and mortality were assessed using multivariable Cox proportional hazards models, associations between nutritional status and CKD progression were assessed using multivariable Fine-Gray models.

RESULTS

610 patients were included (mean age 76.6 ± 5.8 years, mean eGFR 14.8 ± 3.1 mL/min/1.73 m2), with 160 patients (26.2%) at risk of malnutrition. During follow-up, 55 patients (9.0%) died and 154 patients (25.2%) experienced CKD progression. Patients at risk of malnutrition had significantly higher 1-year mortality risk (adjusted hazard ratio or HR 1.88, 95% CI 1.08; 3.25) but not significantly higher CKD progression risk (adjusted subdistributional-HR 1.06, 95% CI 0.71; 1.59).

CONCLUSION

Older patients with advanced CKD and malnutrition risk face significantly higher 1-year mortality risk but not higher CKD progression risk. These findings may help identify vulnerable patients who are at high risk of early mortality who may benefit from dietary interventions.