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Kidney Week

Abstract: PO1728

Nutritional Phenotypes and Variation in Nutritional Parameter Trajectories Among Non-Dialysis CKD (CKD-ND) Patients Prescribed Oral Nutritional Supplements

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
  • Zheng, Yuyan, BC Provincial Renal Agency, Vancouver, British Columbia, Canada
  • Renouf, Dani, Providence Health Care, Vancouver, British Columbia, Canada
  • Levin, Adeera, The University of British Columbia, Vancouver, British Columbia, Canada
Background

Among CKD-ND patients at risk of undernutrition/protein-energy wasting, the definition of patient subgroups most likely to benefit from ONS treatment is not known. Therefore, our aims were to identify phenotypes of non-dialysis CKD patients prescribed ONS, and to assess nutritional parameter slopes before and after ONS use, by phenotype.

Methods

This longitudinal cohort study included 2543 adult CKD-ND patients who entered multidisciplinary CKD clinics across British Columbia during 2010- 2019, met weight and/or dietary intake criteria for ONS prescription based on dietitian assessment, received ≥1 ONS prescription. Hierarchical cluster analysis was used to identify phenotypes using baseline nutritional parameters. Using linear mixed models, slopes for body mass index (BMI), serum albumin, bicarbonate, phosphate, and neutrophil-to-lymphocyte ratio (NLR), an inflammation marker, were assessed in the 2-year periods before and after the first ONS prescription.

Results

Cluster analysis identified five nutritional phenotypes. Changes in parameter slopes (Δslope = post-ONS slope - pre-ONS slope) varied by cluster (Figure). Cluster 1 (characterized by the highest mean NLR and the lowest mean BMI among clusters) demonstrated statistically significant positive Δslopes for BMI, albumin and bicarbonate, and a negative Δslope for NLR. Cluster 2 (hypoalbuminemia) demonstrated positive Δslopes for BMI, albumin, and phosphate. Cluster 3 (low mean BMI) demonstrated a positive Δslope for BMI, accompanied by negative Δslopes for albumin and bicarbonate, and a positive Δslope for NLR. Cluster 4 (acidosis) demonstrated positive Δslopes for BMI and bicarbonate. In Cluster 5 (highest BMI), a negative Δslope for albumin and a positive Δslope for NLR were observed (no improvement with ONS).

Conclusion

The variation in response to ONS by cluster subgroup lends support to an individualized approach to nutritional management of patients at risk of undernutrition/protein-energy wasting.

Funding

  • Government Support – Non-U.S.