The Effect of Nutritional Interventions on Long-Term Patient Survival in Advanced Chronic Kidney Disease

Abstract

Patients with end-stage kidney disease (ESKD) are at high risk of malnutrition and subsequent related mortality when starting dialysis. However, there have been few clinical studies on the effect of nutritional interventions on long-term patient survival. A 2-year longitudinal study was conducted from January 2012 to December 2016. A total of 186 patients with non-dialysis ESKD started the nutritional education program (NEP), and 169 completed it. A total of 128 patients participated in a NEP over 6 months (personalized diet, education and oral supplementation, if needed). The control group (n = 45) underwent no specific nutritional intervention. The hospitalization rate was significantly lower for the patients with NEP (13.7%) compared with the control patients (26.7%) (p = 0.004). The mortality odds ratio for the patients who did not receive NEP was 2.883 (95% CI 0.993–8.3365, p = 0.051). The multivariate analysis showed an independent association between mortality and age (OR, 1.103; 95% CI 1.041–1.169; p = 0.001) and between mortality and the female sex (OR, 3.332; 95% CI 1.054–10.535; p = 0.040) but not between mortality and those with NEP (p = 0.051). Individualized nutrition education has long-term positive effects on nutritional status, reduces hospital admissions and increases survival among patients with advanced CKD who are starting dialysis programs.

Influence of Nutrients on Kidney Diseases

“…They found that the amount of inorganic P ingested was associated with the ratio of urinary P to urea nitrogen excreted (P/UUN ratio), but that the amount of P ingested from animal and vegetable sources was not associated with the P/UUN ratio in 24 h urine samples [ 10 ]. Thus, the P/UUN ratio in 24 h urine samples may be a useful means of estimating inorganic P intake [ 11 ]. This finding may help in the management of mineral bone disorder in patients with CKD, in which the estimation and control of serum P concentration are important.…”

“…Perez-Torres et al demonstrated the long-term (2-year) effects of a nutritional intervention, referred to as a nutritional educational program, in 186 patients with advanced CKD [ 11 ]. This nutritional educational program consisted of an individualized diet plan based on each patient’s initial nutritional status, four nutritional education sessions, a nutritional assessment, and 6 months of monitoring [ 11 ].…”

“…Perez-Torres et al demonstrated the long-term (2-year) effects of a nutritional intervention, referred to as a nutritional educational program, in 186 patients with advanced CKD [ 11 ]. This nutritional educational program consisted of an individualized diet plan based on each patient’s initial nutritional status, four nutritional education sessions, a nutritional assessment, and 6 months of monitoring [ 11 ]. The intervention was administered by a single dietitian and aimed to provide a personalized dietary prescription, including the provision of 25–35 kcal/kg/day energy and 0.75–1.0 g/kg/day protein, according to the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines [ 11 ].…”

“…This nutritional educational program consisted of an individualized diet plan based on each patient’s initial nutritional status, four nutritional education sessions, a nutritional assessment, and 6 months of monitoring [ 11 ]. The intervention was administered by a single dietitian and aimed to provide a personalized dietary prescription, including the provision of 25–35 kcal/kg/day energy and 0.75–1.0 g/kg/day protein, according to the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines [ 11 ]. The authors assessed the patients’ protein and energy intakes, the phosphorus and potassium contents of the foods, the cooking techniques used, and a fourth parameter selected according to the patients’ specific needs [ 11 ].…”

“…The intervention was administered by a single dietitian and aimed to provide a personalized dietary prescription, including the provision of 25–35 kcal/kg/day energy and 0.75–1.0 g/kg/day protein, according to the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines [ 11 ]. The authors assessed the patients’ protein and energy intakes, the phosphorus and potassium contents of the foods, the cooking techniques used, and a fourth parameter selected according to the patients’ specific needs [ 11 ]. They developed a detailed dietary plan after obtaining information from a 3-day dietary record [ 11 ], and used photographic albums to estimate portion sizes and explain to patients how to read and understand food labels [ 11 ].…”