Association between kidney function, nutritional status and anthropometric measures in older people
Authors: Guligowska Agnieszka , Corsonello Andrea , Pigłowska Małgorzata , Roller-Wirnsberger Regina , Wirnsberger Gerhard , Ärnlöv Johan , Carlsson Axel C. , Tap Lisanne , Mattace-Raso Francesco , Formiga Francesc , Moreno-Gonzalez Rafael , Freiberger Ellen , Sieber Cornel , Gregorio Pedro Gil , Martínez Sara Laínez , Artzi-Medvedik Rada , Yehoshua Ilan , Fabbietti Paolo , Lattanzio Fabrizia , Kostka Tomasz ,   on behalf of SCOPE investigators, Lattanzio Fabrizia , Corsonello Andrea , Bustacchini Silvia , Bolognini Silvia , D’Ascoli Paola , Moresi Raffaella , Di Stefano Giuseppina , Giammarchi Cinzia , Bonfigli Anna Rita , Galeazzi Roberta , Lenci Federica , Bella Stefano Della , Bordoni Enrico , Provinciali Mauro , Giacconi Robertina , Giuli Cinzia , Postacchini Demetrio , Garasto Sabrina , Cozza Annalisa , Guarasci Francesco , D’Alia Sonia , Firmani Romano , Nacciariti Moreno , Di Rosa Mirko , Fabbietti Paolo , Wirnsberger Gerhard Hubert , Roller-Wirnsberger Regina Elisabeth , Herzog Carolin , Lindner Sonja , Mattace-Raso Francesco , Tap Lisanne , Ziere Gijsbertus , Goudzwaard Jeannette , Kostka Tomasz , Guligowska Agnieszka , Kroc Łukasz , Sołtysik Bartłomiej K. , Pigłowska Małgorzata , Wójcik Agnieszka , Chrząstek Zuzanna , Sosowska Natalia , Telążka Anna , Kostka Joanna , Fife Elizaveta , Smyj Katarzyna , Zel Kinga , Artzi-Medvedik Rada , Melzer Yehudit , Clarfield Mark , Melzer Itshak , Yehoshua Ilan , Melzer Yehudit , Formiga Francesc , Moreno-González Rafael , Corbella Xavier , Martínez Yurema , Polo Carolina , Cruzado Josep Maria , Gregorio Pedro Gil , Martínez Sara Laínez , Alonso Mónica González , Herrero Calvo Jose A. , Molina Fernando Tornero , Fuentes Lara Guardado , García Pamela Carrillo , Pérez María Mombiedro , Renz Alexandra , Muck Susanne , Theobaldy Stephan , Bekmann Andreas , Kaltsa Revekka , Britting Sabine , Kob Robert , Weingart Christian , Freiberger Ellen , Sieber Cornel , Ärnlöv Johan , Carlsson Axel , Feldreich Tobias 
Published: October 2020

Abstract
Background
Different mechanisms connect the nutritional status with the occurrence and the course of chronic kidney disease (CKD). The end-stage renal disease is complicated by catabolic inflammatory reactions and cachexia which leads to malnutrition (undernutrition). On the other hand, obesity is an important risk factor for the development and acceleration of CKD.

Methods
In the SCOPE study, community-dwelling persons aged 75 years and over, from 6 European countries and Israel were examined at the baseline phase. We assessed the relationship between anthropometric measures (Body Mass Index (BMI), circumferences of arm (AC), waist (WC), hip (HC), and calf (CC), waist-to-hip ratio - WHR, waist-to-height ratio - WHtR, risk of malnutrition (Mini Nutritional Assessment - MNA), serum albumin) and estimated glomerular filtration rate (eGFR) calculated by Berlin Initiative Study (BIS) equation.

Results
We studied 2151 subjects (932 men and 1219 women) with a mean age of 79.5 ± 5.9 years. A total of 1333 (62%) participants had CKD (GRF < 60 ml/min/1.73 m2). Negative correlations between eGFR and weight, AC, WC, HC, CC, BMI, WHtR were observed. Positive correlation occurred between eGFR and MNA score (Spearman’s rho = 0.11) and albumin concentration (rho = 0.09). Higher weight, AC, WC, HC, CC, BMI and WHtR increased the odds ratio of CKD; higher MNA (OR = 0.98, 95% CI 0.94–1.0) and higher serum albumin (OR = 0.73, 95% CI 0.53–1.0) were weakly associated with reduced odds. The risk of malnutrition was the highest with eGFR < 30 as compared to eGFR > 60 (OR = 2.95, 95%CI = 1.77–4.94 for MNA < 24; OR = 5.54, 95%CI = 1.66–18.5 for hypoalbuminemia < 3.5 g/dL).

Conclusion
The population of community dwelling people aged 75+ with CKD shows general features of overweight and obesity with a small prevalence of malnutrition. For anthropometric measures, the strongest association with eGFR and the highest odds of CKD were identified using WC, HC, CC and WHtR. Albumin level and MNA, but not MNA Short Form, indicated an increased odds of malnutrition with a decrease in eGFR.