Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5: The EQUAL Cohort Study

EQUAL Study Investigators

doi:10.1053/j.jrn.2021.03.006

Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5: The EQUAL Cohort Study

EQUAL Study Investigators

Karolinska Institutet and Karolinska University Hospital
Danderyds Hospital
University Hospital Würzburg
Wroclaw Medical University
Leiden University Medical Centre
Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension
Department of renal medicine
National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objective: The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease. Design and Methods: The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observational cohort study involving six European countries. We included 1,103 adults >65 years with incident estimated glomerular filtration rate <20 mL/min/1.73 m² not on dialysis, attending nephrology care. Nutritional status was assessed with the 7-point Subjective Global Assessment tool (7-p SGA), patient-reported outcomes with RAND-36 and the Dialysis Symptom Index. Logistic regression was used to estimate the associations between potential risk factors and SGA decline. Results: The majority of the patients had a normal nutritional status at baseline, 28% were moderately malnourished (SGA ≤5). Overall, mean SGA decreased by −0.18 points/year, (95% confidence interval −0.21; −0.14). More than one-third of the study participants (34.9%) deteriorated in nutritional status (1 point decline in SGA) and 10.9% had a severe decline in SGA (≥2 points). The proportion of patients with low SGA (≤5) increased every 6 months. Those who dropped in SGA also declined in estimated glomerular filtration rate and mental health score. Every 10 points decrease in physical function score increased the odds of decline in SGA by 23%. Lower physical function score at baseline, gastrointestinal symptoms, and smoking were risk factors for impaired nutritional status. There was an interaction between diabetes and physical function on SGA decline. Conclusions: Nutritional status deteriorated in more than one-third of the study participants during the first year of follow-up. Lower patient-reported physical function, more gastrointestinal symptoms, and current smoking were associated with decline in nutritional status.

Original language	English
Pages (from-to)	161-169
Number of pages	9
Journal	Journal of renal nutrition
Volume	32
Issue number	2
Early online date	27 Apr 2021
DOIs	https://doi.org/10.1053/j.jrn.2021.03.006
Publication status	Published - Mar 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 2 Zero Hunger
SDG 3 Good Health and Well-being

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10.1053/j.jrn.2021.03.006

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@article{9c7c7369a55b48d2955b91860935ca0a,

title = "Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5: The EQUAL Cohort Study",

abstract = "Objective: The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease. Design and Methods: The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observational cohort study involving six European countries. We included 1,103 adults >65 years with incident estimated glomerular filtration rate <20 mL/min/1.73 m2 not on dialysis, attending nephrology care. Nutritional status was assessed with the 7-point Subjective Global Assessment tool (7-p SGA), patient-reported outcomes with RAND-36 and the Dialysis Symptom Index. Logistic regression was used to estimate the associations between potential risk factors and SGA decline. Results: The majority of the patients had a normal nutritional status at baseline, 28\% were moderately malnourished (SGA ≤5). Overall, mean SGA decreased by −0.18 points/year, (95\% confidence interval −0.21; −0.14). More than one-third of the study participants (34.9\%) deteriorated in nutritional status (1 point decline in SGA) and 10.9\% had a severe decline in SGA (≥2 points). The proportion of patients with low SGA (≤5) increased every 6 months. Those who dropped in SGA also declined in estimated glomerular filtration rate and mental health score. Every 10 points decrease in physical function score increased the odds of decline in SGA by 23\%. Lower physical function score at baseline, gastrointestinal symptoms, and smoking were risk factors for impaired nutritional status. There was an interaction between diabetes and physical function on SGA decline. Conclusions: Nutritional status deteriorated in more than one-third of the study participants during the first year of follow-up. Lower patient-reported physical function, more gastrointestinal symptoms, and current smoking were associated with decline in nutritional status.",

author = "\{EQUAL Study Investigators\} and Karin Windahl and Irving, \{Gerd Fax{\'e}n\} and Tora Almquist and Lid{\'e}n, \{Maarit Korkeila\} and Peter Stenvinkel and Chesnaye, \{Nicholas C\} and Christiane Drechsler and Maciej Szymczak and Magdalena Krajewska and Fu, \{Edouard L\} and Claudia Torino and Gaetana Porto and Paul Roderick and Caskey, \{Fergus J\} and Christoph Wanner and Dekker, \{Friedo W\} and Jager, \{Kitty J\} and Marie Evans",

note = "Funding Information: Support: Funding was received from the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom. Funding Information: The authors would like to thank all the patients and health professionals participating in the EQUAL study. Funding was received from the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom. Funding Information: Financial Disclosure: F.J.C. has received speaker fees from Baxter and research funding from NIHR and Kidney Research UK . M.E. report payment for advisory board (Astellas, Astra Zeneca, Vifor Pharma), payment for lectures (Astellas, Vifor Pharma, Fresenius) and institutional grants not related to this study (Astra Zeneca, Astellas). P.S. report payment for advisory board (Baxter, Astra Zeneca, Reata), payment for lectures (Astellas, Baxter, Pfizer, Amgen) and institutional grants not related to this study (Astra Zeneca, Bayer). C.W. has received honoraria from multiple sources ( http://era-edta.org/doi ) outside the present work. K.J. reports payment of lectures (Fresenius). K.W., C.T., G.P., M.K., M.K.L., G.F.I., T.A., N.C., C.D., M.S., E.F., P.R., F.D. have no financial disclosures. Funding Information: Financial Disclosure: F.J.C. has received speaker fees from Baxter and research funding from NIHR and Kidney Research UK. M.E. report payment for advisory board (Astellas, Astra Zeneca, Vifor Pharma), payment for lectures (Astellas, Vifor Pharma, Fresenius) and institutional grants not related to this study (Astra Zeneca, Astellas). P.S. report payment for advisory board (Baxter, Astra Zeneca, Reata), payment for lectures (Astellas, Baxter, Pfizer, Amgen) and institutional grants not related to this study (Astra Zeneca, Bayer). C.W. has received honoraria from multiple sources (http://era-edta.org/doi) outside the present work. K.J. reports payment of lectures (Fresenius). K.W., C.T., G.P., M.K., M.K.L., G.F.I., T.A., N.C., C.D., M.S., E.F., P.R., F.D. have no financial disclosures.Support: Funding was received from the European Renal Association?European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom.The authors would like to thank all the patients and health professionals participating in the EQUAL study. Funding was received from the European Renal Association?European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2022",

month = mar,

doi = "10.1053/j.jrn.2021.03.006",

language = "English",

volume = "32",

pages = "161--169",

journal = "Journal of renal nutrition",

issn = "1051-2276",

publisher = "W.B. Saunders Ltd",

number = "2",

}

TY - JOUR

T1 - Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5

T2 - The EQUAL Cohort Study

AU - EQUAL Study Investigators

AU - Windahl, Karin

AU - Irving, Gerd Faxén

AU - Almquist, Tora

AU - Lidén, Maarit Korkeila

AU - Stenvinkel, Peter

AU - Chesnaye, Nicholas C

AU - Drechsler, Christiane

AU - Szymczak, Maciej

AU - Krajewska, Magdalena

AU - Fu, Edouard L

AU - Torino, Claudia

AU - Porto, Gaetana

AU - Roderick, Paul

AU - Caskey, Fergus J

AU - Wanner, Christoph

AU - Dekker, Friedo W

AU - Jager, Kitty J

AU - Evans, Marie

N1 - Funding Information: Support: Funding was received from the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom. Funding Information: The authors would like to thank all the patients and health professionals participating in the EQUAL study. Funding was received from the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom. Funding Information: Financial Disclosure: F.J.C. has received speaker fees from Baxter and research funding from NIHR and Kidney Research UK . M.E. report payment for advisory board (Astellas, Astra Zeneca, Vifor Pharma), payment for lectures (Astellas, Vifor Pharma, Fresenius) and institutional grants not related to this study (Astra Zeneca, Astellas). P.S. report payment for advisory board (Baxter, Astra Zeneca, Reata), payment for lectures (Astellas, Baxter, Pfizer, Amgen) and institutional grants not related to this study (Astra Zeneca, Bayer). C.W. has received honoraria from multiple sources ( http://era-edta.org/doi ) outside the present work. K.J. reports payment of lectures (Fresenius). K.W., C.T., G.P., M.K., M.K.L., G.F.I., T.A., N.C., C.D., M.S., E.F., P.R., F.D. have no financial disclosures. Funding Information: Financial Disclosure: F.J.C. has received speaker fees from Baxter and research funding from NIHR and Kidney Research UK. M.E. report payment for advisory board (Astellas, Astra Zeneca, Vifor Pharma), payment for lectures (Astellas, Vifor Pharma, Fresenius) and institutional grants not related to this study (Astra Zeneca, Astellas). P.S. report payment for advisory board (Baxter, Astra Zeneca, Reata), payment for lectures (Astellas, Baxter, Pfizer, Amgen) and institutional grants not related to this study (Astra Zeneca, Bayer). C.W. has received honoraria from multiple sources (http://era-edta.org/doi) outside the present work. K.J. reports payment of lectures (Fresenius). K.W., C.T., G.P., M.K., M.K.L., G.F.I., T.A., N.C., C.D., M.S., E.F., P.R., F.D. have no financial disclosures.Support: Funding was received from the European Renal Association?European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom.The authors would like to thank all the patients and health professionals participating in the EQUAL study. Funding was received from the European Renal Association?European Dialysis and Transplant Association (ERA-EDTA), the Swedish Medical Association (SLS), the Stockholm County Council ALF, Njurfonden (Sweden), Center for Innovative Medicine (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom. Publisher Copyright: © 2021 The Authors

PY - 2022/3

Y1 - 2022/3

N2 - Objective: The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease. Design and Methods: The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observational cohort study involving six European countries. We included 1,103 adults >65 years with incident estimated glomerular filtration rate <20 mL/min/1.73 m2 not on dialysis, attending nephrology care. Nutritional status was assessed with the 7-point Subjective Global Assessment tool (7-p SGA), patient-reported outcomes with RAND-36 and the Dialysis Symptom Index. Logistic regression was used to estimate the associations between potential risk factors and SGA decline. Results: The majority of the patients had a normal nutritional status at baseline, 28% were moderately malnourished (SGA ≤5). Overall, mean SGA decreased by −0.18 points/year, (95% confidence interval −0.21; −0.14). More than one-third of the study participants (34.9%) deteriorated in nutritional status (1 point decline in SGA) and 10.9% had a severe decline in SGA (≥2 points). The proportion of patients with low SGA (≤5) increased every 6 months. Those who dropped in SGA also declined in estimated glomerular filtration rate and mental health score. Every 10 points decrease in physical function score increased the odds of decline in SGA by 23%. Lower physical function score at baseline, gastrointestinal symptoms, and smoking were risk factors for impaired nutritional status. There was an interaction between diabetes and physical function on SGA decline. Conclusions: Nutritional status deteriorated in more than one-third of the study participants during the first year of follow-up. Lower patient-reported physical function, more gastrointestinal symptoms, and current smoking were associated with decline in nutritional status.

AB - Objective: The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease. Design and Methods: The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observational cohort study involving six European countries. We included 1,103 adults >65 years with incident estimated glomerular filtration rate <20 mL/min/1.73 m2 not on dialysis, attending nephrology care. Nutritional status was assessed with the 7-point Subjective Global Assessment tool (7-p SGA), patient-reported outcomes with RAND-36 and the Dialysis Symptom Index. Logistic regression was used to estimate the associations between potential risk factors and SGA decline. Results: The majority of the patients had a normal nutritional status at baseline, 28% were moderately malnourished (SGA ≤5). Overall, mean SGA decreased by −0.18 points/year, (95% confidence interval −0.21; −0.14). More than one-third of the study participants (34.9%) deteriorated in nutritional status (1 point decline in SGA) and 10.9% had a severe decline in SGA (≥2 points). The proportion of patients with low SGA (≤5) increased every 6 months. Those who dropped in SGA also declined in estimated glomerular filtration rate and mental health score. Every 10 points decrease in physical function score increased the odds of decline in SGA by 23%. Lower physical function score at baseline, gastrointestinal symptoms, and smoking were risk factors for impaired nutritional status. There was an interaction between diabetes and physical function on SGA decline. Conclusions: Nutritional status deteriorated in more than one-third of the study participants during the first year of follow-up. Lower patient-reported physical function, more gastrointestinal symptoms, and current smoking were associated with decline in nutritional status.

UR - https://www.scopus.com/pages/publications/85115692726

U2 - 10.1053/j.jrn.2021.03.006

DO - 10.1053/j.jrn.2021.03.006

M3 - Article

C2 - 33931314

SN - 1051-2276

VL - 32

SP - 161

EP - 169

JO - Journal of renal nutrition

JF - Journal of renal nutrition

IS - 2

ER -

Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5: The EQUAL Cohort Study

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