Abstract
BackgroundAlthough chronic kidney disease (CKD) patients are particularly prone to malnutrition, systematic nutritional screening is rarely routinely performed during hospitalization. The primary aim of this study was to determine the prevalence of malnutrition (as captured by the nutritional screening score NRS) in hospitalized CKD patients and explore the impact of malnutrition on hospital mortality.MethodsAll patients admitted to the tertiary nephrology department of the University hospital of Bern Inselspital over a period of 12 months were included in this observational study. The risk for malnutrition was assessed within 24h of admission by the NRS. Demographic, clinical, and outcome data were extracted from the patient database. The primary outcome was in-hospital mortality. The secondary outcomes were length of hospitalization and hospitalization costs. Multilevel mixed-effect logistic regression model analysis was performed to determine the association of in-hospital mortality and risk of malnutrition (NRS score≥3).ResultsWe included 696 eligible hospitalizations of 489 CKD patients. Hospitalized patients had a median age of 64 years (interquartile range (IQR), 52–72), 35.6% were at risk of malnutrition (NRS≥3). After adjustment for the identified confounders (Case weight, Barthel index, and CKD stage) multivariate analysis confirmed an independent and significant association between higher in-hospital mortality with NRS≥3 [OR 2.92 (95% CI: 1.33–6.39), P<0.001]. Furthermore, in multivariate analysis the risk of malnutrition was associated with longer length of hospitalization [Geometric mean ratio: 1.8 (95% CI: 1.5–2.0), p<0.001] and with increased hospitalization costs [Geometric mean ratio: 1.7 (95% CI: 1.5–1.9), p<0.001]).ConclusionsMalnutrition in CKD patients, as captured by NRS>3, is highly prevalent among hospitalized CKD patient and associated with prolonged hospital stay and increased in-hospital mortality.
Highlights
The prevalence of malnutrition in chronic patients is substantial and varies significantly depending on the screening instruments used for assessment
The primary aim of this study was to determine the prevalence of malnutrition in hospitalized Chronic kidney disease (CKD) patients and explore the impact of malnutrition on hospital mortality
Hospitalized patients had a median age of 64 years (interquartile range (IQR), 52–72), 35.6% were at risk of malnutrition (NRS 3)
Summary
The prevalence of malnutrition in chronic patients is substantial and varies significantly depending on the screening instruments used for assessment. Chronic kidney disease (CKD) patients are commonly depleted of protein and energy stores and prone to develop malnutrition [6, 7]. Many CKD patients with a high risk of malnutrition remain undetected during hospitalization, due to the lack of standardized nutritional screening tools. Several studies have found associations between nutritional risk and adverse clinical outcome using various screening tools such as the Subjective Global Assessment (SGA) [8], the Malnutrition Screening Tool (MST) and the Nutrition Risk Screening 2002 (NRS) [9]. Chronic kidney disease (CKD) patients are prone to malnutrition, systematic nutritional screening is rarely routinely performed during hospitalization. The primary aim of this study was to determine the prevalence of malnutrition (as captured by the nutritional screening score NRS) in hospitalized CKD patients and explore the impact of malnutrition on hospital mortality.
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