Dr Jessica Dawson1,2, Ms Ann-Maree Randall3,4, Ms Michele Ryan4, Mr Frank P Brennan5, Dr Chenlei-Kelly Li5,6, Mr Cameron McLean1, Dr Brendan J Smyth2,5, Mr Max Thomsett5, Professor Mark A Brown5,6
1Department of Nutrition and Dietetics, St George Hospital, Sydney, Australia, 2NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia, 3Department of Nutrition and Dietetics, Nepean Hospital, Kingsford, Australia, 4Western Renal Service, Sydney, Australia, 5Department of Renal Medicine, St George Hospital, Sydney, Australia, 6School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney, Australia
Aim: Describe the 2-year survival rate of people assessed as malnourished and frail from commencement of treatment for advanced chronic kidney disease (CKD) with either Conservative Kidney Management (CKM) or dialysis.
Background: Malnutrition and frailty are associated with increased morbidity and mortality. There is poor data regarding the impact of malnutrition and frailty on survival rates in people with advanced CKD.
Methods: 2-year prospective study of people who commenced CKM or dialysis. Participants were recruited between July 2018 and September 2020 at their initial CKM appointment or within 1 month of commencing dialysis. Frailty and malnutrition were assessed using the Fried’s Frailty Index and 7-Point Subjective Global Assessment (SGA), respectively.
Results: 85 participants were recruited with an average age of 80.7 years and average eGFR 11ml/min/1.73m2. 70% of participants were commencing CKM, 33% of participants were assessed as malnourished and 65% were assessed as frail. Overall median survival was 656 days with 47% survival at 2 years. Comparing frail and not frail participants there was no difference in the rate of death (HR 1.66, 95% CI 0.0 to 3.2, p = 0.123) and no difference in 2-year survival rate between frail (41%) and not frail (57%) (p=0.27). Malnourished participants had a 2-times increased rate of death, compared to well-nourished participants (HR 2.05, 95% CI 1.1 to 3.7, p = 0.02). The 2-year survival rate for malnourished and well-nourished was 32% and 54% (p=0.05), respectively.
Conclusion: Despite frailty being more prevalent, malnutrition was associated with significantly lower rates of survival. Larger studies are needed to further evaluate the impact of both frailty and malnutrition on both quality of life and mortality in advanced CKD.
Biography:
Jess is a research fellow and renal dietitian with over 10 years clinical experience. Jess’s goal is to combine her clinical practice with innovative research in nutritional management to improve care and outcomes in people with chronic kidney disease. Jess’ interests and experience are in novel interventions to improve dietary behaviours and for the management of people choosing Conservative Kidney Management.