SUN-125 NUTRITIONAL STATUS AND ORAL NUTRITIONAL SUPPLEMENT USE AMONG PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE IN BRITISH COLUMBIA, CANADA

Abstract

Undernutrition and protein-energy wasting (PEW) are complications of advanced chronic kidney disease (CKD) that are associated with increased risk of mortality and morbidity. In British Columbia, a Nutritional Supplement Policy is stewarded by renal dietitians and guides prescription of oral nutritional supplements (ONS) for CKD patients of all eGFR levels who have unintentional weight loss >10% in past 6 months, current weight of <90% of desirable body weight, inadequate nutrient intake (<80% of recommended intake), or a hypercatabolic state. Given the paucity of studies assessing ONS use among non-dialysis CKD patients at risk for undernutrition and PEW, we aimed to characterize nutritional status and ONS treatment patterns in this population. This has not been previously evaluated in a Canadian setting. We conducted a retrospective study of non-dialysis CKD patients who entered and were followed at multidisciplinary CKD clinics in the province of British Columbia, Canada between January 2013 and December 2018. We used Wilcoxon signed-rank test to compare baseline nutrition and inflammation parameters within 6 months of entry to the CKD clinics between patients with at least one ONS prescription within 1 year of entry, and patients not prescribed ONS. Using descriptive statistics, longitudinal ONS prescription patterns over 3 years were analyzed in the subset of patients who entered the CKD clinics during 2013 to 2015. 15859 patients who entered the CKD clinic during 2013 to 2018 were included in the analysis of nutritional lab parameters. Of these, 1389 patients (9%) were eligible for and prescribed ONS within 1 year of CKD clinic entry. Patients taking ONS had lower eGFR, greater age, lower body mass index, lower serum albumin, higher phosphate, lower bicarbonate, higher ferritin, higher PTH, lower hemoglobin and higher neutrophil-to-lymphocyte ratio compared with those who did not receive ONS (see Table). Differences in lab parameters between patients prescribed ONS and patients not prescribed ONS persisted when analyzed by age category and eGFR category. In the longitudinal analysis of ONS prescription patterns (N=7611), overall ONS use in the 1st, 2nd, and 3rd year of CKD clinic follow-up remained stable (8.3%, 8.0%, 8.9% of patients, respectively), with approximately 40% new ONS users and 60% previous ONS users during the 2nd and 3rd year of follow-up. Among patients who were prescribed ONS within the first year after entry to CKD clinics and who continued follow-up in the subsequent year, 38% discontinued ONS use, 35% received 1-2 ONS prescriptions/year, and 27% received 3+ ONS prescriptions/year. Among non-dialysis CKD patients in British Columbia, 9% of patients received ONS treatment within 1 year of CKD clinic entry. These patients were identified by dietitian assessment as having undernutrition, and their nutritional status was corroborated by anthropometric and lab parameters. ONS prescription patterns demonstrate responsible prescribing and de-prescribing of ONS in a non-dialysis CKD population within a universal health care system. Future analyses will assess the effect of ONS on patient outcomes including progression to end-stage kidney disease and patient-reported symptom burden.