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Zhao A, Wu L, Lin L, Li S, Liao X, Chen L, Lin Y. The geriatric nutritional risk index is related to adverse hospitalization outcomes in individuals undergoing cardiac surgery. Sci Rep 2024; 14:19126. [PMID: 39155300 PMCID: PMC11330975 DOI: 10.1038/s41598-024-69668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024] Open
Abstract
Malnutrition is linked to adverse outcomes in post-cardiac surgery patients. This study investigates the correlation between the Geriatric Nutritional Risk Index (GNRI) and adverse hospital outcomes in patients following cardiac surgery. This retrospective study included elderly patients with heart disease who were admitted to the Department of Cardiology, Fujian Medical University Union Hospital from January 2020 to December 2022. Patients were divided into two groups based on the cut-off value (98 g/dL). Data from 407 patients were assessed, with 278 (68.3%) classified as having nutritional risk and 129 (31.7%) as having no nutritional risk. Notable distinctions were observed in body weight, BMI, and left ventricular ejection fraction (P < 0.05). Laboratory indicators indicated lower levels of serum albumin, lymphocytes, red blood cells, hemoglobin, admission blood glucose, and admission triglyceride in the nutritional risk group (P < 0.05). Neutrophils and serum creatinine were higher in the nutritional risk group (P < 0.05). Poor prognosis was prevalent in the nutrition risk group (64.7%), with higher incidences of adverse outcomes (P < 0.05). Univariate and multivariate studies showed that GNRI < 98 g/dL was an independent predictor of postoperative cardiac surgery. Nutritional risk was an important predictor of adverse hospital outcomes after the surgery.
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Affiliation(s)
- Ani Zhao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Lijun Wu
- Department of Nursing, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Lingyu Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Sailan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Xiaoqin Liao
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian Province, China.
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China.
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Cheng K, Zhang J, Ye LY, Lin MH, Ding XY, Zheng XE, Zhou XF. Geriatric nutrition risk index in the prediction of all-cause and cardiovascular mortality in older adults with hyperlipidemia: NHANES 1999-2018. BMC Geriatr 2024; 24:634. [PMID: 39068440 PMCID: PMC11282714 DOI: 10.1186/s12877-024-05232-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Malnutrition is linked to a higher risk of unfavorable outcomes in various illnesses. The present investigation explored the correlation between inadequate nutritional condition and outcomes in older individuals diagnosed with hyperlipidemia. METHODS The geriatric nutritional risk index (GNRI) was used to evaluate the nutritional status. All patients were divided into two groups according to GNRI. A Kaplan-Meier analysis was used to assess the survival rates of different groups at risk of malnutrition. In addition, GNRI was used in COX proportional risk regression models to evaluate its predictive effect on both overall mortality and cardiovascular mortality among patients with hyperlipidemia. Furthermore, the study employed restricted cubic splines (RCS) to examine the nonlinear correlation between GNRI and mortality. RESULTS The study included 4,532 elderly individuals diagnosed with hyperlipidemia. During a median follow-up duration of 139 months, a total of 1498 deaths from all causes and 410 deaths from cardiovascular causes occurred. The Kaplan-Meier analysis demonstrated significantly poorer survival among individuals at risk of malnutrition, as indicated by the GNRI. In the malnutrition risk group, the modified COX proportional hazards model revealed that a decrease in GNRI was associated with a higher risk of all-cause mortality (HR=1.686, 95% CI 1.212-2.347) and cardiovascular mortality (HR=3.041, 95% CI 1.797-5.147). Furthermore, the restricted cubic splines revealed a non-linear association between GNRI and both all-cause mortality and cardiovascular mortality (p-value for non-linearity = 0.0039, p-value for non-linearity=0.0386). CONCLUSIONS In older patients with hyperlipidemia, lower levels of GNRI are associated with mortality. The GNRI could potentially be used to predict all-cause mortality and cardiovascular mortality.
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Affiliation(s)
- Kun Cheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Jing Zhang
- Second Department of Infectious Disease, Shanghai Fifth People's Hospital of Fudan University, Shanghai, 200240, China
| | - Lu-Ya Ye
- Medical Intensive Care Unit, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian, China
| | - Mou-Hui Lin
- The School of Clinical Medicine Department, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Xiao-Yan Ding
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Xiao-E Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Xiao-Fen Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China.
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, China.
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Kitamura M, Yamashita H, Sugiyama S, Kuroki R, Fukuda H, Sawase A, Tsuchiyama A, Takehara K, Watanabe J, Takazono T, Imamura R, Mukae H, Nishino T. Unplanned hemodialysis initiation: A retrospective analysis of patient characteristics and prognosis in an emergency hospital. Ther Apher Dial 2024. [PMID: 38946143 DOI: 10.1111/1744-9987.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/22/2024] [Accepted: 06/13/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Functional decline occurs during dialysis initiation, particularly in unplanned cases. To prevent unplanned hemodialysis, we aimed to identify associated factors from the first referral to the nephrology department to hemodialysis initiation and assess patient prognosis post-unplanned hemodialysis initiation. METHODS This retrospective study involved 257 Japanese patients initiating hemodialysis and compared patient characteristics based on whether hemodialysis was planned or unplanned at a single center. Patient outcomes were evaluated in collaboration with maintenance hemodialysis centers. RESULTS Unplanned hemodialysis initiation correlated with heart failure history (p < 0.05) and infections like pneumonia (p < 0.001). Patients with unplanned hemodialysis initiation had a worse prognosis than those with planned initiation (p < 0.001), and multivariable Cox regression showed it as an independent risk factor for death (p < 0.05). CONCLUSIONS Hygiene and careful attention to heart failure may reduce unplanned hemodialysis and improve patient well-being and healthcare efficiency. This retrospective analysis highlights crucial considerations for optimizing the initiation of hemodialysis.
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Affiliation(s)
- Mineaki Kitamura
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Yamashita
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sayaka Sugiyama
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryoma Kuroki
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Haruka Fukuda
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Sawase
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ayaka Tsuchiyama
- Department of Urology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Kosuke Takehara
- Department of Urology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Junichi Watanabe
- Department of Urology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryoichi Imamura
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Zheng T, Sun H, Tang Y, Zeng Y, Yan L. Association of lower urinary tract symptoms and geriatric nutritional risk index in men: a cross-sectional study based on NHANES. Front Med (Lausanne) 2024; 11:1356921. [PMID: 38975054 PMCID: PMC11224433 DOI: 10.3389/fmed.2024.1356921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/13/2024] [Indexed: 07/09/2024] Open
Abstract
Background Despite previous literature exploring the factors influencing lower urinary tract symptoms (LUTS), few studies have examined the relationship between nutritional status and LUTS. Objectives The objective of this research was to evaluate the relationship between LUTS and Geriatric Nutritional Risk Index (GNRI) in middle-aged and older men. Methods We included 2,607 men in the NHANES 2005-2006 and 2007-2008 cycles for cross-sectional analysis. We screened for LUTS based on four specific questions on the relevant questionnaire. We calculated GNRI according to the relevant calculation formula and included other covariates. Multivariate logistic analysis using GNRI as the principal independent variable and adjusting for other covariates were used to determine the association with LUTS, nocturia, and daytime LUTS. Results According to the responses to the questionnaire, out of 2,607 eligible participants, 471 had LUTS, 906 had nocturia, and 819 had daytime LUTS. In the unadjusted regression model, LUTS (OR = 0.93, 95% CI = 0.91-0.96, p < 0.001), nocturia (OR = 0.90, 95% CI = 0.88-0.93, p < 0.001), and daytime LUTS (OR = 0.96, 95% CI = 0.94-0.99, p = 0.002) were significantly negatively associated with GNRI. After adjustment by adding covariates, LUTS (OR = 0.97,95% CI =0.94-0.99, p = 0.026) and nocturia (OR = 0.94, 95% CI =0.91-0.93, p < 0.001) were significantly negatively associated with GNRI. Conclusion Low GNRI was associated with the development of LUTS. In the prevention and treatment of LUTS, urologists should consider the impact of nutritional status on LUTS, and interventions for nutritional status may prevent and improve LUTS.
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Affiliation(s)
- Tianyun Zheng
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Huaibin Sun
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, China
| | - Yueqing Tang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuan Zeng
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Yan
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
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Ren H, Zhu M, Yu H, Weng Y, Yu W. Preoperative geriatric nutritional risk index and neutrophil-to-lymphocyte ratio relate to postoperative acute kidney injury in elderly patients undergoing laparoscopic abdominal surgery. Food Nutr Res 2024; 68:10564. [PMID: 38868623 PMCID: PMC11167701 DOI: 10.29219/fnr.v68.10564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 06/14/2024] Open
Abstract
Background Acute kidney injury (AKI) poses a significant concern in elderly patients undergoing laparoscopic abdominal surgery due to increased vulnerability arising from aging, comorbidities, and surgery-related factors. Early detection and intervention are crucial for mitigating short- and long-term consequences. This study aims to investigate the correlation between preoperative Geriatric Nutritional Risk Index (GNRI), neutrophil-to-lymphocyte ratio (NLR), and the occurrence of postoperative AKI in elderly patients undergoing laparoscopic abdominal surgery, as well as to assess the predictive value of their combined detection for postoperative AKI. Methods A retrospective study involving 347 elderly patients (aged 60 years or older) undergoing laparoscopic abdominal surgery explored the relationship between preoperative GNRI, NLR, and postoperative AKI. GNRI was calculated based on serum albumin and body weight ratios, while NLR was derived from preoperative blood tests. Results The combined GNRI and NLR test demonstrated superior predictive value (area under the curve [AUC] = 0.87) compared to individual markers. Multivariate logistic analysis identified age, American Society of Anesthesiologists (ASA) grade, comorbidities, preoperative GNRI, and NLR as independent risk factors for AKI. Correlation analysis affirmed a negative correlation between preoperative GNRI and AKI severity, and a positive correlation between preoperative NLR and AKI severity. Conclusion The preoperative GNRI and NLR have clinical values in predicting postoperative AKI in elderly patients undergoing laparoscopic abdominal surgery.
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Affiliation(s)
- Hengchang Ren
- Department of Anesthesiology, Tianjin First Central Hospital, Tianjin China
| | - Min Zhu
- Department of Anesthesiology, Tianjin First Central Hospital, Tianjin China
| | - Hongli Yu
- Department of Anesthesiology, Tianjin First Central Hospital, Tianjin China
| | - Yiqi Weng
- Department of Anesthesiology, Tianjin First Central Hospital, Tianjin China
| | - Wenli Yu
- Department of Anesthesiology, Tianjin First Central Hospital, Tianjin China
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Wu J, Cheng X, Yang H, Xiao S, Xu L, Zhang C, Huang W, Jiang C, Wang G. Geriatric nutritional risk index as a prognostic factor in elderly patients with non-muscle-invasive bladder cancer: a propensity score-matched study. Int Urol Nephrol 2024; 56:1627-1637. [PMID: 38177927 DOI: 10.1007/s11255-023-03905-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The Geriatric Nutrition Risk Index (GNRI) is a simple and validated tool used to assess the nutritional status of elderly patients and predict the risk of short-term postoperative complications, as well as the long-term prognosis, after cancer surgery. In this study, we aimed to evaluate the predictive value of GNRI for the long-term postoperative prognosis in elderly patients with primary non-muscle-invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TURBT). METHODS We retrospectively analyzed data from 292 elderly patients with primary NMIBC. Using X-tile software, we divided the cohort into two groups based on GNRI and determined the cut-off value for postoperative recurrence-free survival (RFS). Propensity score matching (PSM) with a ratio of 1:3, Kaplan-Meier analysis, log-rank test, and COX proportional hazards regression were used to assess the correlation between GNRI and prognosis and identify factors predicting recurrence and progression. RESULTS In the entire cohort, the 3 year recurrence group had significantly lower GNRI compared to the 3 year non-recurrence group (P = 0.0109). The determined GNRI cut-off value was 93.82. After PSM, the low GNRI group had significantly lower RFS (P < 0.0001) and progression-free survival (PFS) (P = 0.0040) than the high GNRI group. Multivariate COX regression showed that GNRI independently predicted RFS (HR 2.108; 95% CI 1.266-3.512; P = 0.004) and PFS (HR 2.155; 95% CI 1.135-4.091; P = 0.019) in elderly patients with primary NMIBC. CONCLUSION Preoperative GNRI is a prognostic marker for disease recurrence and progression in elderly patients with primary NMIBC undergoing TURBT.
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Affiliation(s)
- Jingxin Wu
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Xiaofeng Cheng
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Heng Yang
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Song Xiao
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Linhao Xu
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Cheng Zhang
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Wei Huang
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Chunwen Jiang
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Gongxian Wang
- Department of Urological Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China.
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Huang Y, Wu R, Xia Q, Liu L, Feng G. Prognostic values of geriatric nutrition risk index on elderly patients after spinal tuberculosis surgery. Front Nutr 2023; 10:1229427. [PMID: 37614748 PMCID: PMC10442490 DOI: 10.3389/fnut.2023.1229427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Abstract
Background Spinal tuberculosis (STB) is a significant public health concern, especially in elderly patients, due to its chronic and debilitating nature. Nutritional status is a critical factor affecting the prognosis of STB patients. The geriatric nutritional risk index (GNRI) has been established as a reliable predictor of adverse outcomes in various diseases, but its correlation with surgical outcomes in elderly STB patients has not been studied. Objective The study aimed to assess the prognostic value of the GNRI in elderly patients with STB who underwent surgery. Methods We conducted a retrospective analysis of medical records of elderly patients (65 years or older) diagnosed with active STB who underwent surgical treatment. Data collection included patient demographics, comorbidities, clinical history, laboratory testing, and surgical factors. GNRI was calculated using serum albumin levels and body weight. Postoperative complications were observed and recorded. The patients were followed up for at least 1 year, and their clinical cure status was assessed based on predefined criteria. Results A total of 91 patients were included in the study. We found that a GNRI value of <98.63 g/dL was a cutoff value for predicting unfavorable clinical prognosis in elderly STB patients undergoing surgery. Patients with a low GNRI had higher Charlson Comorbidity Index scores, were more likely to receive red blood cell transfusions, and had a higher prevalence of overall complications, particularly pneumonia. The unfavorable clinical prognosis group had lower GNRI scores compared to the favorable prognosis group. Multivariate analysis showed that lower GNRI independently predicted unfavorable clinical outcomes in elderly STB patients. Conclusion The study concluded that the GNRI is a valuable biomarker for predicting prognosis in elderly STB patients undergoing surgical intervention. Patients with lower GNRI scores had worse outcomes and a higher incidence of complications.
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Affiliation(s)
- Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruibang Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Piccoli GB, Cederholm T, Avesani CM, Bakker SJL, Bellizzi V, Cuerda C, Cupisti A, Sabatino A, Schneider S, Torreggiani M, Fouque D, Carrero JJ, Barazzoni R. Nutritional status and the risk of malnutrition in older adults with chronic kidney disease - implications for low protein intake and nutritional care: A critical review endorsed by ERN-ERA and ESPEN. Clin Nutr 2023; 42:443-457. [PMID: 36857954 DOI: 10.1016/j.clnu.2023.01.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
Increased life expectancy is posing unprecedented challenges to healthcare systems worldwide. These include a sharp increase in the prevalence of chronic kidney disease (CKD) and of impaired nutritional status with malnutrition-protein-energy wasting (PEW) that portends worse clinical outcomes, including reduced survival. In older adults with CKD, a nutritional dilemma occurs when indications from geriatric nutritional guidelines to maintain the protein intake above 1.0 g/kg/day to prevent malnutrition need to be adapted to the indications from nephrology guidelines, to reduce protein intake in order to prevent or slow CKD progression and improve metabolic abnormalities. To address these issues, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Renal Nutrition group of the European Renal Association (ERN-ERA) have prepared this conjoint critical review paper, whose objective is to summarize key concepts related to prevention and treatment of both CKD progression and impaired nutritional status using dietary approaches, and to provide guidance on how to define optimal protein and energy intake in older adults with differing severity of CKD. Overall, the authors support careful assessment to identify the most urgent clinical challenge and the consequent treatment priority. The presence of malnutrition-protein-energy wasting (PEW) suggests the need to avoid or postpone protein restriction, particularly in the presence of stable kidney function and considering the patient's preferences and quality of life. CKD progression and advanced CKD stage support prioritization of protein restriction in the presence of a good nutritional status. Individual risk-benefit assessment and appropriate nutritional monitoring should guide the decision-making process. Higher awareness of the challenges of nutritional care in older adult patients with CKD is needed to improve care and outcomes. Research is advocated to support evidence-based recommendations, which we still lack for this increasingly large patient subgroup.
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Affiliation(s)
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Uppsala University. Theme Inflammation & Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Carla Maria Avesani
- Department of Clinical Science, Technology and Intervention, Division of Renal Medicine and Baxter Novum, Karolinska Institute, Stockholm, Sweden
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Vincenzo Bellizzi
- Nephrology and Dialysis Division - Department of Medical Sciences, Hospital "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Alice Sabatino
- UO Nefrologia, Azienda Ospedaliera- Universitaria Parma, Parma, Italy
| | - Stephane Schneider
- Gastroenterology and Nutrition, Nice University Hospital, Université Côte d'Azur, Nice, France
| | - Massimo Torreggiani
- Néphrologie et dialyse, Centre Hospitalier Le Mans, Avenue Rubillard, 72037, Le Mans, France
| | - Denis Fouque
- Renal Department, Lyon SUD Hospital, Hospices Civils de Lyon, Université de Lyon, Pierre Benite, France
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
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