Malnutrition Linked to Higher Risk of CKD and Mortality in Seniors

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Malnutrition is linked to a significantly increased incidence of chronic kidney disease (CKD) and a higher risk of mortality in older adults. This association, measured by the geriatric nutritional risk index (GNRI), was observed in both the National Health and Nutrition Examination Survey (NHANES) and UK Biobank databases, with malnourished individuals being significantly more likely to develop CKD and face higher mortality rates.

It is estimated that CKD will be the 5th most common cause of mortality by 2040 due in part to the increasing aging of the population on a global level. The condition can lead to the need for dialysis and transplantation and can raise the risk of cardiovascular disease. Therefore, identifying the risk factors for both development and progression of the disease is crucial.

“Malnutrition is a main complication of CKD and may further promote the progression of CKD and lead to poor outcomes,” wrote a team of investigators from the Huazhong University of Science and Technology in Wuhan, China. “Most previous studies have focused on the assessment, prevention and management of malnutrition in CKD patients, especially in Asian populations. Limited evidence has been established regarding the associations between malnutrition and the incidence and risk of CKD.”

Common adverse events associated with malnutrition include mood changes, frailty, muscle wasting, a decreased quality of life, cognitive impairment, osteoporosis, decreased immunocompetence and death.

Investigators used data from the UK Biobank and NHANES to identify patients with CKD over the age of 60 years who had GNRI data available. Any associations between the GNRI and the risk of malnutrition and mortality among this patient population were assessed.

In total, 13,162 individuals from the NHANES and 66,326 individuals from the UK Biobank were included in the study. Of these patients, 6,135 and 16,662, respectively, were diagnosed with CKD. Most of these patients were male (74% and 52%, respectively) and the average age of patients was 72.3 years in the NHANES and 64.9 years in the UK Biobank. Median follow-up times were longer in the UK Biobank cohort (162 months) compared with the NHANES group (81 months).

Results showed patients with a lower GNRI were more likely to have a CKD diagnosis. The odds of having CKD were about 38% higher for people with lower GNRI scores compared to those with higher scores in the NHANES cohort. In the UK Biobank arm, the odds were even higher—more than double—with these patients being 2.35 times more likely to have CKD. Both findings were statistically significant, meaning the results are unlikely due to chance. A lower GNRI was also linked to an increased risk of death among these patients.

Despite differences in age, sex, race, lifestyle and education, findings demonstrated a consistent and significant increased risk of CKD among elderly individuals that had high nutritional risk.

Investigators noted the long follow-up time and the large sample size of patients strengthened the study. However, the sample sizes of some of the subgroups were limited. Additionally, they were unable to account for changes in nutritional status during the follow-up period as the GNRI was only measured at baseline.

“The assessment and management of malnutrition may help prevent and manage the development and progression of CKD,” investigators concluded. “Future studies are needed to investigate direct causal inference and the role of malnutrition management in the prevention of CKD.”