Nutritional disorders and survival rate of elderly and geriatric patients with CKD 3B-5 stage

BACKGROUND. The prevalence of CKD in the population of the elderly and geriatric patients is varies from 23.4% to 35.8%. Nutritional status was recognized as an important factor of CKD prognosis. One of the factors affecting their survival is nutritional status. There have not been many studies on the effect of eating disorders on the survival of elderly and senile patients with CKD.

THE AIM: to assess the impact of nutritional status on the survival of elderly patients with CKD stages 3b-5.

PATIENTS AND METHODS. We’ve studied 190 people with CKD stages 3b-5 (eGFR<45 ml/min/m2) with an average age of 76 [67;86]. Exclusion criteria’s: dialysis, acute cardiovascular disorders, oncology, and psychiatric disorders. Nutritional status was assessed by Subjective Global Assessment scale, the 5-year risk of the death was evaluated absolute by the Bansal scale. The duration of study - 36 month.

RESULTS. In the group of elderly and geriatric patients with CKD stages 3b-5, normal nutritional status was determined in 40.1% of patients, mild to moderate malnutrition in 54.7%, and protein-energy wasting (PEW) in 5.2%; up to 2.8% of patients were underweight. The best 3-year survival rate was observed in patients with normal nutritional status, mild nutritional status disorders and obesity, the worst survival rate - in patients with PEW and underweight (p<0,001).  In the group of patients with CKD stage 4 the average Bansal score scale was 8 points, which corresponds to 69% of the absolute risk of death within 5 years; in patients with CKD stage 5, the average score was also 8 [7, 8].

CONCLUSION. In the group of elderly and geriatric patients with CKD stage 3b-5 and PEW survival rate was significantly lower than in patients without nutritional disorders and mild nutritional disorders; we didn’t find correlation between the estimated absolute risk of death according to the Bansal scale and actual survival in 3-year observation period.

1. Farrington K, Covic A, Nistor I et al. Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR<45 mL/min/1.73 m2): a summary document from the European Renal Best Practice Group. Nephrol Dial Transplant 2017 Jan 1;32(1):9–16. doi: 10.1093/ndt/gfw411. PMID: 28391313

2. Fabbian F, De Giorgi A, Guarino M et al. Impact of chronic kidney disease on mortality in older adults treated with pacemaker implantation. J GeriatrCardiol 2017;14(10):597–603. doi: 10.11909/j.issn.1671-5411.2017.10.007

3. Hill NR, Fatoba ST, Oke JL et al. Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis. PLoS One 2016;11(7):e0158765. doi: 10.1371/journal.pone.0158765

4. Kalantar-Zadeh K, Kovesdy CP, Streja E et al. Transition of care from pre-dialysis prelude to renal replacement therapy: the blueprints of emerging research in advanced chronic kidney disease. Nephrol Dial Transplant 2017;32(suppl_2):ii91–ii98. doi: 10.1093/ndt/gfw357

5. Ko GJ, Obi Y, Soohoo M et al. No Survival Benefit in Octogenarians and Nonagenarians with Extended Hemodialysis Treatment Time. Am J Nephrol 2018;48(5):389-398. doi: 10.1159/000494336

6. Kuzyarova AS, Gasanov MZ, Batyushin MM, Golubeva OV. Molecular bases of muscular definition: the role of myostatin and proteinkinase β in progression of protein-energy waste in patients on hemodialysis. The Russian Archives of Internal Medicine 2019;9(2):126–132 (In Russ.). doi: 10.20514/2226-6704-20199-2-126-132

7. Kanazawa Y, Nakao T, Murai S et al. Diagnosis and prevalence of protein energy wasting and its association with mortality in Japanese haemodialysis patients. Nephrology 2017;22(7):541–547. doi: 10.1111/nep.12814

8. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int 2021 Mar;99(3S):S1–S87. doi: 10.1016/j.kint.2020.11.003. PMID: 33637192

9. Borkhanova EG, Islamova GM, Maksudova AN. Prevalence of malnutrition in elderly patients with chronic kidney disease. Practical medicine 2021;19(4):89–92 (In Russ.). doi: 10.32000/20721757-2021-4-89-92

10. Borkhanova EG, Maksudova AN, Alaskari et al. Nutritional disorders among elderly and senile patients depending on the state of renal function. Clinical nephrology 2022;14(2):19–24 (In Russ.). doi: 10.18565/nephrology.2022.2.19-24

11. Bansal N, Katz R, Boer I et al. Development and Validation of a Model to Predict 5-Year Risk of Death without ESRD among Older Adults with CKD. Clin J Am Soc Nephrol 2015;10(3):363–371. doi: 10.2215/CJN.04650514

12. Ikizler TA, Burrowes JD, Byham-Gray LD et al. KDOQI Nutrition in CKD Guideline Work Group. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis 2020;76(3)(suppl 1):S1–S107. doi: 10.1053/j.ajkd.2020.05.006

13. Tkacheva ON, Tutelyan VA, Shestopalov AE et al. Nutritional insuf ciency (malnutrition) in older adults. Clinical recommendations. Russian Journal of Geriatric Medicine 2021;(1):15–34. (In Russ.) https://doi.org/10.37586/2686-8636-1-2021-15-34

14. Hansrivijit P, Chen YJ, Lnu K et al. Prediction of mortality among patients with chronic kidney disease: A systematic review. World J Nephrol 2021;10(4):59–75. doi: 10.5527/wjn.v10.i4.59

15. Jagadeswaran D, Indhumathi E, Hemamalini AJ et al. Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients. Clin Nutr 2019;38(1):341–347. doi: 10.1016/j.clnu.2018.01.001

16. Mei F, Gao Q, Chen F et al. Frailty as a Predictor of Negative Health Outcomes in Chronic Kidney Disease: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2021;22(3):535–543.e7. doi: 10.1016/j.jamda.2020.09.033