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

Annika Bargetzi¹, Nora Emmenegger², Simone Wildisen², Manuela Nickler³, Laura Bargetzi¹, Lara Hersberger¹, Stephan Segerer⁴, Nina Kaegi-Braun⁵, Pascal Tribolet⁶, Filomena Gomes⁷, Claus Hoess⁸, Vojtech Pavlicek⁸, Stefan Bilz⁹, Sarah Sigrist⁹, Michael Brändle⁹, Christoph Henzen¹⁰, Robert Thomann¹¹, Jonas Rutishauser¹², Drahomir Aujesky¹³, Nicolas Rodondi¹⁴, Jacques Donzé¹⁵, Zeno Stanga¹⁶, Beat Mueller¹, Philipp Schuetz¹⁷

Affiliations

¹ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
² Medical Faculty of the University of Basel, Switzerland.
³ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland.
⁴ Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland.
⁵ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
⁶ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
⁷ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York City, NY, USA.
⁸ Internal Medicine, Kantonsspital Muensterlingen, Switzerland.
⁹ Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland.
¹⁰ Internal Medicine, Kantonsspital Luzern, Switzerland.
¹¹ Internal Medicine, Buergerspital Solothurn, Switzerland.
¹² Internal Medicine, Kantonsspital Baselland, Switzerland.
¹³ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁴ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
¹⁵ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹⁶ Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁷ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland. Electronic address: schuetzph@gmail.com.

PMID: 33933742
DOI: 10.1016/j.clnu.2021.03.013

Free article

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

Annika Bargetzi et al. Clin Nutr. 2021 May.

Free article

. 2021 May;40(5):2762-2771.

doi: 10.1016/j.clnu.2021.03.013. Epub 2021 Mar 15.

Authors

Affiliations

¹ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
² Medical Faculty of the University of Basel, Switzerland.
³ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland.
⁴ Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland.
⁵ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
⁶ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
⁷ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York City, NY, USA.
⁸ Internal Medicine, Kantonsspital Muensterlingen, Switzerland.
⁹ Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland.
¹⁰ Internal Medicine, Kantonsspital Luzern, Switzerland.
¹¹ Internal Medicine, Buergerspital Solothurn, Switzerland.
¹² Internal Medicine, Kantonsspital Baselland, Switzerland.
¹³ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁴ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
¹⁵ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹⁶ Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁷ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland. Electronic address: schuetzph@gmail.com.

PMID: 33933742
DOI: 10.1016/j.clnu.2021.03.013

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 m²).

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.

Keywords: Chronic kidney disease; Clinical outcomes; Kidney function; Malnutrition; Nutritional support; Outcome; Randomized trial; Renal function.

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Conflict of interest statement

Conflicts of interest The study was investigator-initiated and supported by a grant from the Swiss National Foundation to P.Schuetz (SNSF Professorship, PP00P3_150,531) and the Forschungsrat of the Kantonsspital Aarau (1410.000.058 and 1410.000.044). The Institution of P.Schuetz has previously received unrestricted grant money unrelated to this project from Neste Health Science and Abbott Nutrition. The institution of Z.Stanga received speaking honoraria and research support from Neste Health Science, Abbott Nutrition and Fresenius Kabi. Mr. St. Segerer was supported by a grant of the Fundação Pesquisa e Desenvolvimento Humanitario. All other authors report no conflicts of interest. The results presented in this paper have not been published previously in whole or part, except in abstract form.

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

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

Authors

Affiliations

Abstract

Conflict of interest statement

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Associated data

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Medical

Research Materials

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