TY - JOUR
T1 - Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5
T2 - The EQUAL Cohort Study
AU - EQUAL Study Investigators
AU - Windahl, Karin
AU - Irving, Gerd Faxén
AU - Almquist, Tora
AU - Lidén, Maarit Korkeila
AU - Stenvinkel, Peter
AU - Chesnaye, Nicholas C
AU - Drechsler, Christiane
AU - Szymczak, Maciej
AU - Krajewska, Magdalena
AU - Fu, Edouard L
AU - Torino, Claudia
AU - Porto, Gaetana
AU - Roderick, Paul
AU - Caskey, Fergus J
AU - Wanner, Christoph
AU - Dekker, Friedo W
AU - Jager, Kitty J
AU - Evans, Marie
N1 - Funding Information: Support: Funding was received from the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom. Funding Information: The authors would like to thank all the patients and health professionals participating in the EQUAL study. Funding was received from the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom. Funding Information: Financial Disclosure: F.J.C. has received speaker fees from Baxter and research funding from NIHR and Kidney Research UK . M.E. report payment for advisory board (Astellas, Astra Zeneca, Vifor Pharma), payment for lectures (Astellas, Vifor Pharma, Fresenius) and institutional grants not related to this study (Astra Zeneca, Astellas). P.S. report payment for advisory board (Baxter, Astra Zeneca, Reata), payment for lectures (Astellas, Baxter, Pfizer, Amgen) and institutional grants not related to this study (Astra Zeneca, Bayer). C.W. has received honoraria from multiple sources ( http://era-edta.org/doi ) outside the present work. K.J. reports payment of lectures (Fresenius). K.W., C.T., G.P., M.K., M.K.L., G.F.I., T.A., N.C., C.D., M.S., E.F., P.R., F.D. have no financial disclosures. Funding Information: Financial Disclosure: F.J.C. has received speaker fees from Baxter and research funding from NIHR and Kidney Research UK. M.E. report payment for advisory board (Astellas, Astra Zeneca, Vifor Pharma), payment for lectures (Astellas, Vifor Pharma, Fresenius) and institutional grants not related to this study (Astra Zeneca, Astellas). P.S. report payment for advisory board (Baxter, Astra Zeneca, Reata), payment for lectures (Astellas, Baxter, Pfizer, Amgen) and institutional grants not related to this study (Astra Zeneca, Bayer). C.W. has received honoraria from multiple sources (http://era-edta.org/doi) outside the present work. K.J. reports payment of lectures (Fresenius). K.W., C.T., G.P., M.K., M.K.L., G.F.I., T.A., N.C., C.D., M.S., E.F., P.R., F.D. have no financial disclosures.Support: Funding was received from the European Renal Association?European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom.The authors would like to thank all the patients and health professionals participating in the EQUAL study. Funding was received from the European Renal Association?European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom. Publisher Copyright: © 2021 The Authors
PY - 2022/3
Y1 - 2022/3
N2 - Objective: The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease. Design and Methods: The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observational cohort study involving six European countries. We included 1,103 adults >65 years with incident estimated glomerular filtration rate <20 mL/min/1.73 m2 not on dialysis, attending nephrology care. Nutritional status was assessed with the 7-point Subjective Global Assessment tool (7-p SGA), patient-reported outcomes with RAND-36 and the Dialysis Symptom Index. Logistic regression was used to estimate the associations between potential risk factors and SGA decline. Results: The majority of the patients had a normal nutritional status at baseline, 28% were moderately malnourished (SGA ≤5). Overall, mean SGA decreased by −0.18 points/year, (95% confidence interval −0.21; −0.14). More than one-third of the study participants (34.9%) deteriorated in nutritional status (1 point decline in SGA) and 10.9% had a severe decline in SGA (≥2 points). The proportion of patients with low SGA (≤5) increased every 6 months. Those who dropped in SGA also declined in estimated glomerular filtration rate and mental health score. Every 10 points decrease in physical function score increased the odds of decline in SGA by 23%. Lower physical function score at baseline, gastrointestinal symptoms, and smoking were risk factors for impaired nutritional status. There was an interaction between diabetes and physical function on SGA decline. Conclusions: Nutritional status deteriorated in more than one-third of the study participants during the first year of follow-up. Lower patient-reported physical function, more gastrointestinal symptoms, and current smoking were associated with decline in nutritional status.
AB - Objective: The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease. Design and Methods: The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observational cohort study involving six European countries. We included 1,103 adults >65 years with incident estimated glomerular filtration rate <20 mL/min/1.73 m2 not on dialysis, attending nephrology care. Nutritional status was assessed with the 7-point Subjective Global Assessment tool (7-p SGA), patient-reported outcomes with RAND-36 and the Dialysis Symptom Index. Logistic regression was used to estimate the associations between potential risk factors and SGA decline. Results: The majority of the patients had a normal nutritional status at baseline, 28% were moderately malnourished (SGA ≤5). Overall, mean SGA decreased by −0.18 points/year, (95% confidence interval −0.21; −0.14). More than one-third of the study participants (34.9%) deteriorated in nutritional status (1 point decline in SGA) and 10.9% had a severe decline in SGA (≥2 points). The proportion of patients with low SGA (≤5) increased every 6 months. Those who dropped in SGA also declined in estimated glomerular filtration rate and mental health score. Every 10 points decrease in physical function score increased the odds of decline in SGA by 23%. Lower physical function score at baseline, gastrointestinal symptoms, and smoking were risk factors for impaired nutritional status. There was an interaction between diabetes and physical function on SGA decline. Conclusions: Nutritional status deteriorated in more than one-third of the study participants during the first year of follow-up. Lower patient-reported physical function, more gastrointestinal symptoms, and current smoking were associated with decline in nutritional status.
UR - http://www.scopus.com/inward/record.url?scp=85115692726&partnerID=8YFLogxK
U2 - https://doi.org/10.1053/j.jrn.2021.03.006
DO - https://doi.org/10.1053/j.jrn.2021.03.006
M3 - Article
C2 - 33931314
SN - 1051-2276
VL - 32
SP - 161
EP - 169
JO - Journal of Renal Nutrition
JF - Journal of Renal Nutrition
IS - 2
ER -