Abstract
Protein-energy wasting (PEW) is an important complication resulting from chronic kidney disease (CKD). Appetite impairment contributes significantly to PEW in these patients, but risk factors associated with having appetite impairment in patients with CKD remain elusive. Patients with an estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥2 times at least three months apart were prospectively enrolled during 2017, with their demographic features, comorbidities, anthropometric parameters, physical and performance indices, functional status, frailty, sensory organ integrity, and laboratory data collected. Their appetite status was measured using the Council on Nutrition Appetite Questionnaire (CNAQ). We examined independent determinants of appetite impairment in these CKD patients using multiple regression analyses. Among 78 patients with CKD, 42.3% had CNAQ-identified impaired appetite. Those with an impaired appetite also had poorer physical performance, a higher degree of functional impairment, higher frail severities, lower serum sodium levels, less intact oral cavity, and a trend toward having less intact nasal structures than those without. Multiple regression analyses revealed that a higher frail severity, in the forms of increasing Study of Osteoporotic Fractures (SOF) scores (odds ratio (OR), 2.74; 95% confidence interval (CI), 1.15–6.57) and a less intact nasal structure (OR, 0.96; 95% CI, 0.92–0.995) were associated with a higher probability of having an impaired appetite, while higher serum sodium (OR, 0.76; 95% CI, 0.6–0.97) correlated with a lower probability. Based on our findings, in patients with CKD, the severity of frailty, serum sodium, and nasal structural integrity might modify appetite status. Therapies targeting these factors might be beneficial for appetite restoration in patients with CKD.
Highlights
Chronic kidney disease (CKD) is recognized based on abnormalities involving renal structure and/or function persisting for more than three months, and has gradually become a global public health concern since nearly two decades ago
The results showed that frail severities still positively correlated with the probability of having an impaired appetite (OR, 2.74; 95% confidence interval (CI), 1.15–6.57); higher serum sodium levels were associated with a lower probability (OR, 0.76; 95% CI, 0.6–0.97), while having a less intact nasal structure predicted a higher probability (OR, 0.96 per visual analogue scale (VAS) score; 95% CI, 0.92–0.995) of an impaired appetite in patients with chronic kidney disease (CKD) (Table 2)
After accounting for an exhaustive set of variables, we found that frailty, serum sodium levels, and self-reported less intact nasal function modulated the probability of having appetite impairment
Summary
Chronic kidney disease (CKD) is recognized based on abnormalities involving renal structure and/or function persisting for more than three months, and has gradually become a global public health concern since nearly two decades ago. A multitude of pathogenic factors act in concert to initiate and perpetuate PEW in patients with CKD; consensus from the International Society of Renal Nutrition and Metabolism has identified the driving forces responsible for PEW development, including decreased protein/energy intake, hypermetabolism and anabolic resistance associated with CKD, metabolic acidosis, sequels of comorbidity, and dialysis-related factors [4]. Among these factors, inadequate nutrient consumption seems to be more influential than the others. Poor appetite, undoubtedly plays an instrumental role in the pathogenesis of this phenomenon
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