Dietary energy and protein intake assessed based on meal intake rate at dialysis initiation might be associated with 2-year mortality and hospitalization.

BACKGROUND

Dietary intake assessment is necessary for developing appropriate nutritional management aimed at improving patient outcomes. We investigated the association of dietary intake at dialysis initiation, as calculated using data of meal intake rates, with adverse outcomes.

METHODS

Data were collected retrospectively from patients starting hemodialysis (HD) or peritoneal dialysis (PD) during 2016-2018. Dietary energy intake (DEI) and dietary protein intake (DPI) were calculated based on data of nutritional contents of meals provided for patients and meal intake rates recorded by nurses during three days from dialysis initiation. We assessed the association between each of DEI and DPI and primary outcomes: death and hospitalization within 2 years.

RESULTS

This study examined 114 patients starting HD or PD, with median age of 72 (72% male). Cox proportional hazards analyses showed DEI and DPI as associated independently with the primary outcome. Hazard ratios and 95% confidence intervals were 0.94 and 0.91-0.98 for DEI, and 0.22 and 0.09-0.53 for DPI. The relation between each of DEI and DPI and outcomes held true in each subgroup with unplanned dialysis initiation and with pre-frail or frail condition. Receiver operating characteristic analysis results suggest cut-off values of 24.0 kcal/kg/day of DEI and 0.9 g/kg/day of DPI to predict the primary outcome.

CONCLUSION

DEI and DPI, as calculated using data of meal intake rates, are associated independently with 2-year mortality and hospitalization in patients starting dialysis. Patients with unplanned dialysis initiation and with pre-frail or frail condition should be prioritized for nutritional assessment.