TO002WHICH INTERVENTIONS ARE EFFECTIVE IN IMPROVING NUTRITIONAL STATUS IN ELDERLY/FRAIL PATIENTS WITH CKD STAGE 3B-5D? A PRELIMINARY REPORT BY EBPG GROUP

Abstract

Introduction and Aims: Complications involving malnutrition or protein-energy status are common in CKD patients and greatly contributes to morbidity and mortality. Adequate assessment and management of malnutrition are unmet needs in this population. There is an urgent need for an evidenced-based approach to the identification and management of malnutrition in elderly/frail patients with advanced CKD (eGFR < 45ml/min/1.73m2) and in those on dialysis. Methods: The EBPG group carried out a systematic review to determine which nutritional interventions are effective in improving nutritional status in elderly patients (>65 years) with advanced CKD. 1,028 papers were retrieved; 94 (9.1%) selected for full text assessment, and 23 selected for quality assessment and data extraction. Among the remaining studies, only 5 were RCT's, the majority being prospective observational, cross-sectional, or cohort studies. Results: There was no consensus on the definition of nutritional status or on the nutritional parameters which are relevant or need to be addressed in this population. This has resulted in different outcomes being reported as clinical end points in different studies. The majority of studies used biochemical (serum albumin) or clinical (SGA) outcome measures. The main interventions studied were nutritional supplements (oral or intravenous) or pharmacological. Oral nutritional supplements were commonly used, the nature of the supplement differing from study to study and included oral amino acids, mixtures of protein, carbohydrate and fat, and bicarbonate. The same variability was also noted for intradialytic parenteral nutrition (IDPN). Significant improvements of nutritional parameters in response to these interventions were generally reported, mainly increased serum albumin, SGA, or nutritional index. The effects of pharmacological interventions, such as rhGH or nandrolone decanoate, are essentially anecdotal. Dietetic care may be useful throughout the course of CKD. However, there is no definitive evidence of effect of reported interventions on mortality rate. Conclusions: Oral supplements or IDPN may be useful to improve nutritional status in elderly/frail patients with advanced CKD or on dialysis. IDPN seems not to be superior to oral supplementation. There are insufficient data to suggest a pharmacological intervention in this field. Dietary counselling should be part of routine pre-ESRD care.