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Abstract: SA-PO1050

Temporal Changes in Nutritional Markers and Their Association with Mortality in Non-Dialysis Dependent CKD

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1302 Health Maintenance, Nutrition, and Metabolism: Clinical

Authors

  • Patel, Abhishek J., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Mahmoud, Mahmoud A., University of Teneessee Health Science Center, Memphis, Tennessee, United States
  • Akhtar, Jawed, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Wall, Barry M., Veterans Affairs Medical Center, Memphis, Tennessee, United States
  • Kovesdy, Csaba P., Veterans Affairs Medical Center, Memphis, Tennessee, United States
Background

The pathophysiology of protein-energy wasting (PEW) involves both decreased nutrient intake and increased catabolism. The temporal changes of different PEW components and their association with mortality in CKD are not well characterized.

Methods

We examined 234 US veterans with CKD stages 3-5. We assessed serially body weight (BW)/body mass index (BMI), and spot urine urea nitrogen creatinine ratio to estimate 24-hour urine urea nitrogen excretion and daily protein intake (DPI) using the Maroni formula. We estimated the slopes of DPI, BMI and eGFR vs. time in mixed effects models. The association of the slopes of DPI and BMI with all-cause mortality was examined in Cox models adjusted for age, gender, race, diabetes, eGFR and baseline DPI and BMI, respectively.

Results

Patients were 68.6±9.5 years old, 97% male, 38% African-American and 41% diabetic. Mean baseline eGFR, DPI and BMI were 33.1±12.1 ml/min/1.73m2, 0.41±0.15 g/kgBW/day and 30.3±7.1 kg/m2, respectively. Patients had a median (25th-75th percentile) of 5 (3-8) measurements over a median follow-up time of 3.2 years, and 64 patients died (mortality rate 93/1000 patient-years, 95%CI: 73-119). Patients experienced modest but statistically significant decreases in eGFR and BMI over time, but no significant average change in DPI (Table). The slope of DPI was not associated with multivariable adjusted mortality risk (p=0.3), while increase in BMI was associated with a trend towards lower mortality (p=0.1, Figure).

Conclusion

Patients with moderately advanced CKD and relatively stable kidney function experienced small changes in BMI and stable protein intake over time. These modest changes in nutritional markers showed no association with all-cause mortality. Larger studies with longer follow-up are needed to better assess the effects of declining kidney function on different PEW components, and the effects of these changes on survival.

 Slope (95%CI)
eGFR (ml/min/1.73m2/year)-2.09 (-2.84, -1.34), p<0.001
DPI (gm/kgBW/day/year)-0.0024 (-0.0096, 0.0048), p=0.5
BMI (kg/m2/year)-0.28 (-0.45, -0.11), p=0.001