Admission kidney function is a strong predictor for the response to nutritional support in patients at nutritional risk.
Chronic kidney disease
Clinical outcomes
Kidney function
Malnutrition
Nutritional support
Outcome
Randomized trial
Renal function
Journal
Clinical nutrition (Edinburgh, Scotland)
ISSN: 1532-1983
Titre abrégé: Clin Nutr
Pays: England
ID NLM: 8309603
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
12
01
2021
revised:
26
02
2021
accepted:
08
03
2021
pubmed:
3
5
2021
medline:
3
9
2021
entrez:
2
5
2021
Statut:
ppublish
Résumé
Patients with chronic kidney disease (CKD) are at substantial risk of malnutrition, which negatively affects clinical outcomes. We investigated the association of kidney function assessed at hospital admission and effectiveness of nutritional support in hospitalized medical patients at risk of malnutrition. This is a secondary analysis of an investigator-initiated, randomized-controlled, Swiss multicenter trial (EFFORT) that compared individualised nutritional support with usual hospital food on clinical outcomes. We compared effects of nutritional support on mortality in subgroups of patients stratified according to kidney function at the time of hospital admission (estimated glomerular filtration rates [eGFR] <15, 15-29, 30-59, 60-89 and ≥ 90 ml/min/1.73 m We included 1943 of 2028 patients (96%) from the original trial with known admission creatinine levels. Admission eGFR was a strong predictor for the beneficial effects of nutritional support in regard to lowering of 30-day mortality. Patients with an eGFR <15, 15-29 and 30-59 had the strongest mortality benefit (odds ratios [95%CI] of 0.24 [0.05 to 1.25], 0.37 [0.14 to 0.95] and 0.39 [0.21 to 0.75], respectively), while patients with less severe impairment in kidney function had a less pronounced mortality benefits (p for interaction 0.001). A similar stepwise association of kidney function and response to nutritional support was found also for other secondary outcomes. In medical inpatients at nutritional risk, admission kidney function was a strong predictor for the response to nutritional therapy. Initial kidney function may help to individualize nutritional support in the future by identification of patients with most clinical benefit. Registered under ClinicalTrials.gov Identifier no. NCT02517476.
Sections du résumé
BACKGROUND
Patients with chronic kidney disease (CKD) are at substantial risk of malnutrition, which negatively affects clinical outcomes. We investigated the association of kidney function assessed at hospital admission and effectiveness of nutritional support in hospitalized medical patients at risk of malnutrition.
METHODS
This is a secondary analysis of an investigator-initiated, randomized-controlled, Swiss multicenter trial (EFFORT) that compared individualised nutritional support with usual hospital food on clinical outcomes. We compared effects of nutritional support on mortality in subgroups of patients stratified according to kidney function at the time of hospital admission (estimated glomerular filtration rates [eGFR] <15, 15-29, 30-59, 60-89 and ≥ 90 ml/min/1.73 m
RESULTS
We included 1943 of 2028 patients (96%) from the original trial with known admission creatinine levels. Admission eGFR was a strong predictor for the beneficial effects of nutritional support in regard to lowering of 30-day mortality. Patients with an eGFR <15, 15-29 and 30-59 had the strongest mortality benefit (odds ratios [95%CI] of 0.24 [0.05 to 1.25], 0.37 [0.14 to 0.95] and 0.39 [0.21 to 0.75], respectively), while patients with less severe impairment in kidney function had a less pronounced mortality benefits (p for interaction 0.001). A similar stepwise association of kidney function and response to nutritional support was found also for other secondary outcomes.
CONCLUSION
In medical inpatients at nutritional risk, admission kidney function was a strong predictor for the response to nutritional therapy. Initial kidney function may help to individualize nutritional support in the future by identification of patients with most clinical benefit.
CLINICAL TRIAL REGISTRATION
Registered under ClinicalTrials.gov Identifier no. NCT02517476.
Identifiants
pubmed: 33933742
pii: S0261-5614(21)00152-7
doi: 10.1016/j.clnu.2021.03.013
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT02517476']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2762-2771Informations de copyright
Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest The study was investigator-initiated and supported by a grant from the Swiss National Foundation to P.Schuetz (SNSF Professorship, PP00P3_150,531) and the Forschungsrat of the Kantonsspital Aarau (1410.000.058 and 1410.000.044). The Institution of P.Schuetz has previously received unrestricted grant money unrelated to this project from Neste Health Science and Abbott Nutrition. The institution of Z.Stanga received speaking honoraria and research support from Neste Health Science, Abbott Nutrition and Fresenius Kabi. Mr. St. Segerer was supported by a grant of the Fundação Pesquisa e Desenvolvimento Humanitario. All other authors report no conflicts of interest. The results presented in this paper have not been published previously in whole or part, except in abstract form.