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Kidney Week

Abstract: PO2019

Nutritional Status and Oral Nutritional Supplement (ONS) Use Among Patients with Non-Dialysis CKD in British Columbia (BC)

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Wong, Michelle M.Y., The University of British Columbia, Vancouver, British Columbia, Canada
  • Renouf, Dani, St. Paul's Hospital, Vancouver, British Columbia, Canada
  • Zheng, Yuyan, BC Provincial Renal Agency, Vancouver, British Columbia, Canada
  • Sheriff, Zainab, The University of British Columbia, Vancouver, British Columbia, Canada
  • Levin, Adeera, The University of British Columbia, Vancouver, British Columbia, Canada
Background

Malnutrition and protein-energy wasting are complications of advanced CKD that are associated with increased risk of mortality and morbidity. In BC, a government-funded Nutritional Supplement Policy stewarded by renal dietitians guides ONS prescription for CKD patients who meet weight or nutrient intake criteria.

Methods

We conducted a retrospective study of CKD-ND patients who entered multidisciplinary CKD clinics in BC during 2013-2018 (N=15859). We used Wilcoxon signed-rank test to compare baseline nutrition/inflammation parameters among patients with any ONS prescription within 1 year of clinic entry and those not prescribed ONS. Longitudinal ONS prescription patterns over 3 years were described in the 2013-2015 entry cohort (N=7611).

Results

1389 patients (9%) were eligible for and prescribed ONS, with variation between health regions. Patients taking ONS had lower eGFR, BMI, bicarbonate, hemoglobin, and greater age, ferritin, phosphate, PTH, neutrophil-to-lymphocyte ratio compared to those who did not receive ONS (p<0.0001 for all comparisons). Overall ONS use during the first 3 years of follow-up remained stable, with 40% new ONS users and 60% previous ONS users during year 2 and 3 of follow-up. For patients prescribed ONS within the 1st year of clinic entry, 65% had 1-2 ONS prescriptions/year, and among those continuing follow-up in year 2, 38% discontinued ONS, 35% had 1-2 ONS prescriptions/year, and 27% had 3+ ONS prescriptions/year (Figure).

Conclusion

This is the first Canadian study to describe ONS use among CKD-ND, which provides an estmate of incidence of undernutrition, as defined by dietitian assessment and corroborated by nutritional lab parameters. Among patients prescribed ONS, the majority have infrequent ONS use, while another subset has regular ONS use longitudinally.

Funding

  • Government Support - Non-U.S.