#1619 Factors associated with malnutrition in the very elderly with chronic kidney disease
Authors: Herrera Laura Manuela Robayo , Roldán Libia Cristina Pérez , López Begoña Padrones , Muñoz Javier Montero , Menéndez Lucía Ovies , Martínez Jusmer Kennyon Serrano , Menéndez Noelia Boto , García Reyes Galiano , Llano Noelia Avello , García Minerva Rodríguez , Alonso Carlos Gómez , López Álvarez Eva María 
Published: May 2024

Abstract

Background and Aims
The presence of malnutrition in elderly patients with chronic kidney disease (CKD) is associated with adverse events such as mortality, functional decline, and worse outcomes during hospital admission. However, it is not well defined which subgroups would benefit most from nutritional screening, especially considering the difficulty in obtaining certain nutritional parameters like weight in dependent patients.
The objective of this study is to identify which factors are associated with a higher risk of malnutrition in very elderly patients with CKD admitted for acute illness, belonging to the PANCERC cohort.

Method
Cross-sectional observational study conducted with patients ≥85 years old with CKD admitted to an Acute Geriatric Unit due to acute illness over a period of four months. Variables: age, sex, institutionalization, previous Barthel Index (BI), previous Lawton Index (LI), dementia (defined by Reisberg's GDS≥4), frailty (FRAIL scale ≥3), polypharmacy (≥5 drugs), comorbidities (degree of CKD, hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation (AF), anemia, chronic heart failure (CHF), pressure/vascular ulcers, Charlson Comorbidity Index (CCI)), nutritional parameters (Mini Nutritional Assessment-Short Form (MNA-SF), body mass index (BMI), serum cholesterol and albumin), estimated glomerular filtration rate by CKD-EPI (eGFRCKD-EPI) at admission. Malnutrition was defined by a score of ≤7 on the MNA-SF. The chi-square test and t-test were used to analyze the association with the outcome variable. Subsequently, a stepwise logistic regression analysis was conducted to identify factors independently associated with malnutrition.

Results
407 patients were recruited, mean age 90.7±4.1 years, 68.1% female. 32.4% were institutionalized. Previous BI was 59.1 ± 32.3 (BI ≥90 28.7%, BI 60-85 26.3%, BI 40-55 10.6%, BI &lt;40 34.4%); previous LI was 1.7 ± 2 (6.9% LI ≥6, 8.4% LI 4-5, 83.3% LI≤3). 28.3% had dementia. 66.6% were frail, and 90.9% presented polypharmacy. CKD stage: G3a (37.6%), G3b (44.2%), G4 (17.7%), G5 (0.5%). Comorbidities: hypertension (90.7%), CHF (68.3%), anemia (57.5%), dyslipidemia (53.8%), AF (54.5%), diabetes mellitus (37.8), pressure/vascular ulcers (11.1%). The CCI was 2.9 ± 1.8. The mean eGFRCKD-EPI at admission was 37.9 ± 16.6 mL/min/1.73 m2.
MNA-SF score was 9.5±2.4 (18.4% malnutrition), and average BMI was 28±5.5 kg/m2 (29% obesity). 30.5% had dysphagia (18.7% nectar texture, 11.8% pudding texture). The mean serum cholesterol and albumin were 156.3±47.7 mg/dL and 35.5±4.6 g/L.
Variables associated with malnutrition were female sex (OR 2.1 [1.1 to 3.9; p=0.019]), BI&lt;40 (OR 8.8 [5 to 15.7; p &lt; 0.001]), LI ≤3 (OR 1.3 [1.3 to 1.4]; p &lt; 0.001]), dementia (OR 8.3 [4.7 to 14.6; p &lt; 0.001]), frailty (OR 2.4 [1.1 to 5; p = 0.023]), nectar texture dysphagia (OR 2 [1.1 to 3.6; p = 0.018]), pudding texture dysphagia (OR 5 [2.6 to 9.6; p &lt; 0.001]), institutionalization (OR 2.5 [1.5 to 4.2; p=0.001]), pressure/vascular ulcers (OR 4.5 [2.3 to 8.7; p &lt; 0.001]), BMI (−2.7 [−4.1 to −1.3; p &lt; 0.001]), albumin (−3.1 [−4.3 to −2; p &lt; 0.001]).
After adjusting for significant variables, factors that acted as independent predictors of malnutrition were: frailty (OR 3.5 [1.1 to 10.7; p = 0.028]), pressure/vascular ulcers (OR 4.7 [1.5 to 15; p=0.009]), BMI (OR 0.87 [0.81 to 0.94; p=0.001]), pudding texture dysphagia (OR 3 [1 to 8.7; p=0.047]), dementia (OR 8.6 [3.3 to 22.4; p &lt; 0.001]), BI&lt;40 (OR 2.6 [1 to 6.8; p = 0.045]).

Conclusion