Clinical nutrition ESPEN · 2025
Nutritional status and new onset of chronic kidney disease.
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Sato Atsuya, Tanaka Kenichi, Kimura Hiroshi, Saito Hirotaka, Shimabukuro Michio, Asahi Koichi, Watanabe Tsuyoshi, Kazama Junichiro James
Аннотация
BACKGROUND AND AIMS: Malnutrition is associated with adverse outcomes across various populations, but its role in the development of chronic kidney disease (CKD) remains unclear. Our study evaluated relationship between nutritional status and CKD development in patients with CKD risk factors.
METHODS: A total of 1,046 adults with one or more CKD risk factors, an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2, and no proteinuria were examined to investigate the association between nutritional status and new-onset CKD using longitudinal data from the Fukushima Cohort Study. Nutritional status was assessed using the Prognostic Nutritional Index (PNI), the Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT) score. Cox proportional hazards modeling was used to evaluate the association between nutritional status and CKD development. The predictive performance of each nutritional index was assessed using receiver operating characteristic curves.
RESULTS: During follow-up (median, 5.2 years), 325 participants developed CKD. Compared to the highest tertile, participants in the lowest tertile of the PNI showed a significantly increased risk of developing CKD (adjusted hazard ratio, 1.65; 95 % confidence interval, 1.21-2.24). Similar associations were observed for GNRI and CONUT scores in relation to CKD risk. Although the PNI showed a slightly higher AUC than the GNRI and CONUT score, the differences were small and not statistically significant.
CONCLUSION: In this retrospective cohort study, poor nutritional status was associated with increased risk of CKD development in a high-risk population. Nutritional assessment using indices such as the PNI, GNRI, or CONUT score may help identify individuals at elevated risk for CKD, highlighting the potential role of nutritional interventions in CKD prevention. As all three indices showed comparable associations with CKD risk, each may be useful for risk stratification in clinical practice.
METHODS: A total of 1,046 adults with one or more CKD risk factors, an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2, and no proteinuria were examined to investigate the association between nutritional status and new-onset CKD using longitudinal data from the Fukushima Cohort Study. Nutritional status was assessed using the Prognostic Nutritional Index (PNI), the Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT) score. Cox proportional hazards modeling was used to evaluate the association between nutritional status and CKD development. The predictive performance of each nutritional index was assessed using receiver operating characteristic curves.
RESULTS: During follow-up (median, 5.2 years), 325 participants developed CKD. Compared to the highest tertile, participants in the lowest tertile of the PNI showed a significantly increased risk of developing CKD (adjusted hazard ratio, 1.65; 95 % confidence interval, 1.21-2.24). Similar associations were observed for GNRI and CONUT scores in relation to CKD risk. Although the PNI showed a slightly higher AUC than the GNRI and CONUT score, the differences were small and not statistically significant.
CONCLUSION: In this retrospective cohort study, poor nutritional status was associated with increased risk of CKD development in a high-risk population. Nutritional assessment using indices such as the PNI, GNRI, or CONUT score may help identify individuals at elevated risk for CKD, highlighting the potential role of nutritional interventions in CKD prevention. As all three indices showed comparable associations with CKD risk, each may be useful for risk stratification in clinical practice.