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. 2021 Feb 14;13(2):621.
doi: 10.3390/nu13020621.

The Effect of Nutritional Interventions on Long-Term Patient Survival in Advanced Chronic Kidney Disease

Almudena Pérez-Torres  1   2 , M Elena González García  2 , Marta Ossorio-González  2 , Laura Álvarez García  2 , M Auxiliadora Bajo  2 , Gloria Del Peso  2 , Ana Castillo Plaza  2 , Rafael Selgas  2
Affiliations

The Effect of Nutritional Interventions on Long-Term Patient Survival in Advanced Chronic Kidney Disease

Almudena Pérez-Torres et al. Nutrients. .

Abstract

Patients with end-stage kidney disease (ESKD) are at high risk of malnutrition and subsequent related mortality when starting dialysis. However, there have been few clinical studies on the effect of nutritional interventions on long-term patient survival. A 2-year longitudinal study was conducted from January 2012 to December 2016. A total of 186 patients with non-dialysis ESKD started the nutritional education program (NEP), and 169 completed it. A total of 128 patients participated in a NEP over 6 months (personalized diet, education and oral supplementation, if needed). The control group (n = 45) underwent no specific nutritional intervention. The hospitalization rate was significantly lower for the patients with NEP (13.7%) compared with the control patients (26.7%) (p = 0.004). The mortality odds ratio for the patients who did not receive NEP was 2.883 (95% CI 0.993-8.3365, p = 0.051). The multivariate analysis showed an independent association between mortality and age (OR, 1.103; 95% CI 1.041-1.169; p = 0.001) and between mortality and the female sex (OR, 3.332; 95% CI 1.054-10.535; p = 0.040) but not between mortality and those with NEP (p = 0.051). Individualized nutrition education has long-term positive effects on nutritional status, reduces hospital admissions and increases survival among patients with advanced CKD who are starting dialysis programs.

Keywords: chronic kidney disease; diet; malnutrition; nutrition intervention; survival.

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Conflict of interest statement

A. Perez-Torres has received a research grant from Fresenius Kabi España, S. A.U. A.P and E.G. have received travel funding from Abbott nutrition and Nutricia medical nutrition.

Figures

Figure 1
Figure 1
Patient flow diagram, indicating the selection and discontinuation, according to groups. Abbreviation: NEP, Nutrition Education Program.
Figure 2
Figure 2
Protein–energy wasting progression for nutritional educational program plus oral supplementation group and the nutritional educational program only group. Percentage of participants, NEP+ONS or only NEP with PEW at baseline and at the end of the intervention. Abbreviations: NEP, nutrition educational program; ONS, oral nutrition supplementation; PEW, protein energy wasting. p was calculated with the chi-squared test. (*) Statistically significant difference (p < 0.05).
Figure 3
Figure 3
Kaplan–Meier survival curve of patients with end-stage renal disease who underwent or not a personalized nutritional education program.
See this image and copyright information in PMC

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