Wathanavasin Wannasit, Thongprayoon Charat, Kaewput Wisit, Tangpanithandee Supawit, Suppadungsuk Supawadee, Cheungpasitporn Wisit
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Nephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok 10120, Thailand.
Nutrients. 2025 Apr 29;17(9):1508. doi: 10.3390/nu17091508.
BACKGROUND/OBJECTIVES: Malnutrition is a prevalent yet under-recognized condition in patients with advanced chronic kidney disease (CKD), contributing to increased morbidity, mortality, and healthcare burden. The aim of this study is to determine the prevalence and trends of malnutrition and investigate the impact of malnutrition on in-hospital outcomes, treatments, and resource utilization in hospitalized patients with advanced CKD.
This study utilized the National Inpatient Sample (NIS) database to identify hospitalized patients with advanced CKD from 2016 to 2021. This study investigated temporal trends in the prevalence and in-hospital mortality across different degrees of malnutrition in advanced CKD patients. Multivariable regression models were used to assess the association between malnutrition and in-hospital outcomes.
Out of 1,244,415 advanced CKD patients, 67,587 (5.4%) had mild to moderate malnutrition, and 63,785 (5.1%) had severe malnutrition. Malnourished patients exhibited significantly higher in-hospital mortality, with adjusted odds ratios of 1.70 (95% confidence interval (CI), 1.64-1.75) for mild to moderate cases and 2.67 (95% CI, 2.60-2.75) for severe cases. Severely malnourished patients were associated with longer mean hospital stay by 7.0 days and higher hospitalization costs by $97,767 compared with non-malnourished patients. The prevalence of severe malnutrition showed a significant uptrend from 4.2% in 2016 to 5.5% in 2021 ( for trend < 0.001).
Malnutrition in advanced CKD is an increasingly prevalent condition linked to worsened in-hospital outcomes and heightened healthcare resource utilization. The rising trend of severe malnutrition underscores the need for early nutritional screening and the need for future interventional studies to mitigate adverse clinical outcomes in this high-risk population.
背景/目的：营养不良在晚期慢性肾脏病（CKD）患者中普遍存在但未得到充分认识，会导致发病率、死亡率增加以及医疗负担加重。本研究的目的是确定营养不良的患病率和趋势，并调查营养不良对晚期CKD住院患者的院内结局、治疗及资源利用的影响。
本研究利用国家住院样本（NIS）数据库识别2016年至2021年期间的晚期CKD住院患者。本研究调查了晚期CKD患者不同程度营养不良的患病率和院内死亡率的时间趋势。采用多变量回归模型评估营养不良与院内结局之间的关联。
在1,244,415例晚期CKD患者中，67,587例（5.4%）患有轻度至中度营养不良，63,785例（5.1%）患有重度营养不良。营养不良患者的院内死亡率显著更高，轻度至中度病例的调整优势比为1.70（95%置信区间（CI），1.64 - 1.75），重度病例为2.67（95%CI，2.60 - 2.75）。与非营养不良患者相比，重度营养不良患者的平均住院时间延长7.0天，住院费用增加97,767美元。重度营养不良的患病率从2016年的4.2%显著上升至2021年的5.5%（趋势P<0.001）。
晚期CKD患者的营养不良是一种日益普遍的情况，与院内结局恶化和医疗资源利用增加有关。重度营养不良的上升趋势凸显了早期营养筛查的必要性以及未来进行干预性研究以减轻这一高危人群不良临床结局的必要性。
