POS-297 NUTRITIONAL PARAMETER TRAJECTORIES BEFORE AND AFTER ORAL NUTRITIONAL SUPPLEMENT PRESCRIPTION AMONG PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE

Abstract

Protein-energy wasting is a complication of advanced CKD that is associated with increased risk of mortality and cardiovascular and infectious morbidity. In British Columbia (BC), a government-funded Nutritional Supplement Policy, under the stewardship of renal dietitians, guides oral nutritional supplement (ONS) prescription for CKD patients who meet criteria based on degree of weight loss or inadequate nutrient intake, regardless of eGFR. The effectiveness of ONS in the non-dialysis CKD (CKD-ND) population has not been studied previously. Thus, we aimed to assess the association between ONS prescription and longitudinal nutritional status parameters among CKD-ND patients in BC. This analysis included longitudinal data from 3957 adult patients (age >18 years) who entered multidisciplinary CKD clinics in BC between 2010-2019 and who initiated ONS use during CKD clinic follow up. Using a before-after study design, linear mixed effects models with segmented regression were used to determine the slopes of body mass index (BMI), serum albumin, serum bicarbonate, serum phosphate, and neutrophil-to-lymphocyte ratio (NLR, a marker of inflammation) in the 2 years prior to ("pre-ONS") and 2 years after ("post-ONS") the first ONS prescription. Each model was adjusted for sex, age, eGFR, urine albumin-to-creatinine ratio, hypertension, cardiovascular disease, diabetes, health region, and calendar year of the first ONS prescription. The patients had a median age of 76.5 years (IQR 66.5, 83.6), with 46.5% women, and median eGFR of 23 ml/min/1.73 m2(IQR 16, 31). Median time from clinic entry to first ONS prescription was 8.6 months (IQR: 2.0, 24.4). In the "pre-ONS" period, patients demonstrated overall declines in BMI (-0.87 kg/m2/year, 95% CI -0.99 to -0.75), serum albumin (-1.11 g/L/year, 95% CI -1.27 to -0.95), and serum bicarbonate (-0.49 mmol/L/year, 95% CI -0.59 to -0.39), an increase in NLR (0.79/year, 95% CI 0.60 to 0.98), and a slight change in serum phosphate (0.05 mmol/L/year, 95% CI 0.04 to 0.06). Following the first ONS prescription, there were statistically significant increases in BMI slope (+0.91 kg/m2/year, p<0.0001) and albumin slope (+0.82 g/L/year, p<0.0001), as well as a decline in NLR slope of -0.55/year (p<0.0001) (Figure). The change in serum phosphate slope was of small magnitude (+0.02 mmol/L/year, p=0.005), while there was no significant change in bicarbonate slope associated with ONS use (-0.05 mmol/L/year, p=0.4363). Among CKD-ND patients prescribed ONS, there were improvements in longitudinal trajectories of nutrition/inflammation parameters following the first ONS prescription. These results demonstrate effectiveness of the ONS program for CKD-ND patients. Future analyses comparing responses to ONS among different subgroups of patients with protein energy wasting/undernutrition will assist with determining which patients may have the greatest benefit from ONS intervention.