Abstract
Background and objectives: Diabetes is largely prevalent in the chronic kidney disease (CKD) population. Both conditions have metabolic and nutritional abnormalities that affect body composition and the presence of diabetes makes the dietary management of CKD patients more difficult. The aim of this study was to assess peculiar nutritional and functional aspects of diabetic patients in an adult/elderly CKD population, and their predictive significance. Materials and methods: This prospective cohort study included 144 out-patients aged >55 years, affected by stage 3b-4 CKD, on tertiary care clinic; 48 (40 males) were type 2 diabetics and 96 (80 males) were nondiabetics. The two groups have similar age, gender, and residual renal function (30 ± 9 vs. 31 ± 11 mL/min×1.73). All patients underwent a comprehensive nutritional and functional assessment and were followed for 31 ± 14 months. Results: Diabetic CKD patients showed higher waist circumference and fat body mass, lower muscle mass, and lower number of steps per day and average daily METs. Meanwhile, resting energy expenditure (REE), as assessed by indirect calorimetry, and dietary energy intake were similar as well as hand-grip and 6 min walking test. Diabetic patients did not show a greater risk for all-cause mortality and renal death with respect to nondiabetics. Middle arm muscle circumference, phase angle, serum cholesterol, and serum albumin were negatively related to the risk of mortality and renal death after adjustment for eGFR. Conclusions: CKD diabetic patients differed from nondiabetics for a greater fat mass, lower muscle mass, and lower physical activity levels. This occurred at the same REE and dietary energy intake. The outcome of diabetic or nondiabetic CKD patients on tertiary care management was similar in terms of risk for mortality or renal death. Given the same residual renal function, low levels of muscle mass, phase angle, serum albumin, and cholesterol were predictive of poor outcome. Overall, a malnutrition phenotype represents a major predictor of poor outcome in diabetic and nondiabetic CKD patients.
Highlights
Chronic kidney disease (CKD) is prevalent in the elderly and it is often associated with cardiovascular risk, increasing prevalence of frailty, disability and malnutrition [1,2], and comorbid conditions
The outcome of diabetic or nondiabetic chronic kidney disease (CKD) patients on tertiary care management was similar in terms of risk for mortality or renal death
A malnutrition phenotype represents a major predictor of poor outcome in diabetic and nondiabetic CKD patients
Summary
Chronic kidney disease (CKD) is prevalent in the elderly and it is often associated with cardiovascular risk, increasing prevalence of frailty, disability and malnutrition [1,2], and comorbid conditions. Diabetes mellitus is largely prevalent and still increasing Both diabetes and CKD have metabolic and nutritional abnormalities that make dietary management quite difficult, especially in elderly patients with moderate to severe reduction of renal function [3]. Obesity contributes to physical limitations and it is an independent risk factor for CKD and cardiovascular disease [5,6] Obesity is another nutritional concern that may complicate the dietary management of advanced CKD patients. Diabetes is largely prevalent in the chronic kidney disease (CKD) population Both conditions have metabolic and nutritional abnormalities that affect body composition and the presence of diabetes makes the dietary management of CKD patients more difficult. Conclusions: CKD diabetic patients differed from nondiabetics for a greater fat mass, lower muscle mass, and lower physical activity levels
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
