National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Punjab, 160062, India; M.M. College of Pharmacy, M.M. University Ambala, 133203, India.
Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Punjab, 160062, India.
Clin Nutr ESPEN. 2023 Oct;57:683-690. doi: 10.1016/j.clnesp.2023.08.008. Epub 2023 Aug 12.
BACKGROUND & AIMS: Malnutrition is a serious problem that influences morbidity, mortality, functional activity, and quality of life in patients with chronic kidney disease (CKD). However, there has not been much research done on how nutritional status appears to affect mortality in non-dialysis CKD patients. This study aimed to recognize the rates and predictors of fast CKD progression distinguished by nutritional status, and also sought to determine the impact of malnutrition on mortality in non-dialysis CKD patients.
This prospective cohort study (n = 360) involved non-dialysis CKD patients with index estimated glomerular filtration rate (eGFR) between the range of 15-89 ml/min/1.73 m. Nutritional status was evaluated by using the "Pt-Global web tool/PG-SGA". A loss of eGFR >4 ml/min/1.73 m per year was considered to be a sign of fast CKD progression. Kaplan-Meier plots were used to evaluate the cumulative survival, and Cox-proportional hazard models were used to analyze the renal outcomes.
Around 244 (67.8%) of patients have experienced a fast decline in kidney function. In the malnourished group, systolic blood pressure and hyperphosphatemia were observed to have increased hazards for fast CKD progression. The overall incidence of mortality and composite endpoints were found to be 13.9% & 37.6%, respectively. Death rates (11.6%) and composite endpoints (29.8%) were higher in the malnourished (severe & moderate) group. Cox regression hazard model reported 4 times increased hazards for death [HR 4.41 (1.99-9.77) 95% CI; P ≤ 0.005] and 3 times increased hazards for composite endpoints [HR 3.29 (2.10-5.16) 95% CI; P ≤ 0.005] for 'severely malnourished' category in reference to 'normal nutrition' category.
Fast CKD progression was observed to be more common in malnourished patients. Systolic blood pressure and hyperphosphatemia were recognized as potential predictors of fast CKD progression. Moreover, malnutrition was found to be a significant predictor of mortality among non-dialysis CKD patients. The findings of this study advocate for early nutritional evaluation and timely dietary interventions to halt the progression of CKD.
营养不良是一个严重的问题，它会影响慢性肾脏病（CKD）患者的发病率、死亡率、功能活动和生活质量。然而，对于营养状况如何影响非透析 CKD 患者的死亡率，研究还不多。本研究旨在识别营养状况不同的 CKD 快速进展的发生率和预测因素，并确定营养不良对非透析 CKD 患者死亡率的影响。
本前瞻性队列研究（n=360）纳入了指数估计肾小球滤过率（eGFR）在 15-89 ml/min/1.73 m 范围内的非透析 CKD 患者。采用“Pt-Global web tool/PG-SGA”评估营养状况。eGFR 每年下降>4 ml/min/1.73 m 被认为是 CKD 快速进展的标志。采用 Kaplan-Meier 图评估累积生存率，采用 Cox 比例风险模型分析肾脏结局。
约 244 例（67.8%）患者的肾功能出现快速下降。在营养不良组中，收缩压和高磷血症被发现是 CKD 快速进展的危险因素。总的死亡率和复合终点发生率分别为 13.9%和 37.6%。营养不良（严重和中度）组的死亡率（11.6%）和复合终点（29.8%）更高。Cox 回归风险模型报告死亡风险增加 4 倍[HR 4.41（1.99-9.77）95%CI；P≤0.005]，复合终点风险增加 3 倍[HR 3.29（2.10-5.16）95%CI；P≤0.005]，与“正常营养”类别相比，“严重营养不良”类别。
营养不良患者更易发生 CKD 快速进展。收缩压和高磷血症被认为是 CKD 快速进展的潜在预测因素。此外，营养不良是非透析 CKD 患者死亡的一个重要预测因素。本研究的结果提倡早期进行营养评估和及时进行饮食干预，以阻止 CKD 的进展。
