Nutritional Status in Heart Failure Patients throughout Chronic Kidney Disease Stages

Abstract

Background & aims: Heart failure (HF) is associated with significant morbidity and mortality, the prognosis of heart failure is poor, especially with coexisting chronic kidney disease (CKD). However little is known about how HF and CKD together influence the nutritional status, so the main objective of this study was to assess nutritional status in patients with heart failure coexisting with stage 1-5 renal disease. Methods: This retrospective study included a total of 113 patients with HF and CKD that were classified into stages 1-5 according to the Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines. The following characteristics were recorded: co-morbidities, New York Heart Association (NYHA) functional class, echocardiographic data, medication, and biochemical parameters (albumin, hemoglobin and electrolytes). Nutritional status was evaluated by bioimpedance vector analysis (BIVA) and subjective global assessment (SGA). Results: In the nutritional status evaluation by BIVA, 53.1% were cachectic, 23.9% obese and 21.12% normal. The prevalence of cachexia is higher with advancing stages of CKD, while hand grip strength, arm and waist circumferences decreased. In SGA 79.8% had a normal nutritional status, 16.8% mild malnutrition and 2.7% moderate-severe malnutrition. Hypoalbuminemia was presented in 22.5% of subjects, most commonly found in stages 1, 4 and 5; the prevalence of anemia was 47.2% and also increased with advancing stages of CKD, showing a prevalence of 13.3% in stage 1 and 100% stage 5. Conclusions: The prevalence of cachexia was higher in stages 3-5 of CKD, mild to severe malnutrition in stages 4 and 5, and anemia in stage 5, so HF and advanced CKD are associated with deteriorating nutritional status.