A high prevalence of abnormal nutrition parameters found in predialysis end-stage kidney disease: is it a result of uremia or poor eating habits?

Abstract

Objective: To describe the baseline nutritional characteristics of a cohort of end-stage kidney disease (ESKD) patients attending a pre-dialysis clinic.

Setting: Outpatient clinic of a metropolitan tertiary teaching hospital in Sydney, Australia.

Subjects: All ESKD patients attending the multidisciplinary pre-dialysis assessment clinic between April 2002 and March 2008.

Methods: Retrospective analysis of data extracted from the routine initial nutrition assessment records. These included anthropometric and biochemical measures, Subjective Global Assessment, appetite score, presence of symptoms, dietary energy, protein, and other macro- and micronutrient intakes.

Results: Of the 210 patients assessed, 60.5% were male; mean age was 65.7 ± 13.6 years with a mean glomerular filtration rate of 17.3 ± 6.5 mL/min/1.73 m(2); 17.1% and 62.4% were underweight (body mass index <23 kg/m(2)) and overweight or obese (BMI ≥26 kg/m(2)), respectively; 40.5% were rated as malnourished (Subjective Global Assessment scores B and C) with 19.0% overweight/obese and malnourished. Energy and protein intakes correlated positively with glomerular filtration rate, with r = 0.17, P = .01, and r = 0.29, P < .0001 respectively. Mean energy and protein intakes were 23.7 ± 6.7 kcal/kg IBW/day and 1.18 ± 0.42 g/kg IBW/day, with 62.6% and 13.1% not meeting the recommended intake, respectively. The positive predictive values (95%CI) of self-rated appetite score for energy and protein were 0.41 (0.36-0.45) and 0.92 (0.88-0.95), respectively, indicating subjective rating of a good appetite was associated with adequate protein but not energy intake. Fifty-one percent of the patients experienced the symptoms, whereas 17.5% of the patients self-imposed a dietary regimen inappropriately due to beliefs on dietary needs in ESKD. Suboptimal nutrient intakes were observed, including vitamin B2 (41.2%), vitamin E (61.8%), folate (67.6.2%), vitamin D (100.0%), and zinc (64.2%).

Conclusion: Patients presented to the pre-dialysis assessment clinic with abnormal nutrition parameters associated with decreased renal function, symptoms burden, and poor dietary intake. This clinic may provide an opportunity to optimize the nutritional status of ESKD patients in the pre-dialysis period.