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Cited by 49Clinical Nutrition and GastroenterologyDialysis and Renal Disease ManagementNutrition and Health in Aging

Admission kidney function is a strong predictor for the response to nutritional support in patients at nutritional risk

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Bargetzi, Annika, Emmenegger, Nora, Wildisen, Simone, Nickler, Manuela, Bargetzi, Laura, Hersberger, Lara, Segerer, Stephan, Kaegi-Braun, Nina +16 more·2021·Clinical Nutrition
DOI 10.1016/j.clnu.2021.03.013
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Abstract

Background Patients with chronic kidney disease (CKD) are at substantial risk of malnutrition, which negatively affects clinical outcomes. We investigated the association of kidney function assessed at hospital admission and effectiveness of nutritional support in hospitalized medical patients at risk of malnutrition. Methods This is a secondary analysis of an investigator-initiated, randomized-controlled, Swiss multicenter trial (EFFORT) that compared individualised nutritional support with usual hospital food on clinical outcomes. We compared effects of nutritional support on mortality in subgroups of patients stratified according to kidney function at the time of hospital admission (estimated glomerular filtration rates [eGFR] <15, 15-29, 30-59, 60-89 and ≥ 90 ml/min/1.73 m 2). Results We included 1943 of 2028 patients (96%) from the original trial with known admission creatinine levels. Admission eGFR was a strong predictor for the beneficial effects of nutritional support in regard to lowering of 30-day mortality. Patients with an eGFR <15, 15-29 and 30-59 had the strongest mortality benefit (odds ratios [95%CI] of 0.24 [0.05 to 1.25], 0.37 [0.14 to 0.95] and 0.39 [0.21 to 0.75], respectively), while patients with less severe impairment in kidney function had a less pronounced mortality benefits (p for interaction 0.001). A similar stepwise association of kidney function and response to nutritional support was found also for other secondary outcomes. Conclusion In medical inpatients at nutritional risk, admission kidney function was a strong predictor for the response to nutritional therapy. Initial kidney function may help to individualize nutritional support in the future by identification of patients with most clinical benefit. Clinical trial registration Registered under ClinicalTrials.gov Identifier no. NCT02517476.

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  • In EFFORT, patients with eGFR 15-29 ml/min/1.73m2 receiving 0.8 g/kg/day and those with eGFR 30-59 ml/min/1.73m2 receiving 1.2-1.5 g/kg/day showed the strongest benefits on 30-day mortality (OR 0.37, 95% CI 0.14 to 0.95 and OR 0.39, 95% CI 0.21 to 0.75, respectively).

    “However, the degree of kidney impairment was a strong predictor for response to nutritional support and patients with eGFR of 15e29 l/min/1.73m 2 receiving 0.8 g and those with 30e59 ml/min/1.73m 2 receiving 1.2e1.5 g/kg body weight/day showed the strongest benefits on 30day mortality (OR 0.37, 95% CI 0.14 to 0.95 and 0.39, 95% CI 0.21 to 0.75, respectively) (Level of Evidence 1þþ) [89].”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [89]

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  • For polymorbid medical inpatients at nutritional risk with impaired kidney function (eGFR <30 ml/min/1.73m2) who are not on kidney replacement therapy, a low amount of protein of 0.8 g protein/kg body weight/day should be targeted.

    “For polymorbid medical inpatients at nutritional risk with impaired kidney function (eGFR <30 ml/min/1.73m 2 ) who are not on kidney replacement therapy, a low amount of protein of 0.8 g protein/kg body weight/day should be targeted.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [89]

    The Study intervention section sets a target of 0.8 g/kg body weight for patients with eGFR <30, supporting the stated amount and threshold. But the Patient population section says patients on dialysis were included in the eGFR <15 group, so the paper does not limit that target to patients not receiving kidney replacement therapy. The Discussion also says the trial did not validate whether 0.8 g/kg was the optimal target. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Kidney disease predicts response to nutritional treatment, with lower estimated glomerular filtration rates showing stronger clinical benefit.

    “A recent study by Bargetzi et al. found that kidney disease predicted response to nutritional treatment with lower estimated glomerular filtration rates [eGFR] showing stronger clinical benefit [89] (Level of evidence: 1þþ).”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [89]

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Authors
Bargetzi, A., Emmenegger, N., Wildisen, S., Nickler, M., Bargetzi, L., Hersberger, L., Segerer, S., Kaegi-Braun, N., Tribolet, P., Gomes, F., Hoess, C., Pavlicek, V., Bilz, S., Sigrist, S., Brändle, M., Henzen, C., Thomann, R., Rutishauser, J., Aujesky, D., Rodondi, N., Donzé, J., Stanga, Z., Mueller, B., & Schuetz, P.
Affiliations
  • University of Basel (CH)
  • Kantonsspital Aarau (CH)
  • Bern University of Applied Sciences (CH)
  • New York Academy of Sciences (US)
  • Kantonsspital Münsterlingen (CH)
  • Kantonsspital St. Gallen (CH)
  • Luzerner Kantonsspital (CH)
  • Kantonsspital Baselland (CH)
  • University of Bern (CH)
Corresponding author
Schuetz, Philipp
ORCID
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2021-05
Volume
40
Issue
5
Pages
2762-2771
ISSN
0261-5614 (ISSN-L)
DOI
10.1016/j.clnu.2021.03.013
OpenAlex
W3139527853
Cited by
49
References
7
Citations by year
2026: 3 · 2025: 8 · 2024: 14 · 2023: 9 · 2022: 10 · 2021: 5
FWCI
6.09
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • ARBOR - Bern University of Applied Sciences Repository (submittedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc-nd)
Funders
Schweizerischer Nationalfonds
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
chronic kidney disease, malnutrition, nutritional support, estimated glomerular filtration rate, 30-day mortality, medical inpatients, nutritional risk, creatinine
MeSH terms
Aged, Female, Glomerular Filtration Rate, Humans, Kidney, Male, Middle Aged, Nutrition Surveys, Nutritional Status, Risk Factors, Malnutrition, Renal Insufficiency, Chronic

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