Nutritional Parameters Associated With Hospital Mortality in Patients With Acute Kidney Injury

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Background Acute kidney injury (AKI) in hospitalized patients is associated with high morbidity and mortality rates. Nutritional status is a potentially modifiable factor that may influence outcomes. However, the relationship of nutritional status with in-hospital mortality and major adverse kidney events (MAKEs) in critically ill patients with AKI remains unclear. Methods This single-center prospective study involved hospitalized adults with AKI who underwent nutritional evaluation at baseline, which consisted of dietary intake assessments, anthropometric measures and subjective global assessment (SGA). Nutritional intake and SGA scores were determined either via direct evaluation or by reviewing the clinical records of patients who received nutritional support (enteral or parenteral nutrition). Logistic regression was performed to identify variables that were associated with in-hospital mortality. Results One hundred and two patients were included: 73 were men, the mean age was 53±17 years, the main AKI etiologies were sepsis and hypovolemia, half of the patients had AKI 3, and 40% of the patients required renal replacement therapy. Among these patients, 36% died during their hospital stay. One in every four patients (26%) was in a fasting state at the time of AKI diagnosis; oral nutrition was indicated in 53% of patients, and 14% and 7% received enteral and parenteral nutrition, respectively. The protein and energy intakes were 0.45 (0.2–0.7) g/kg and 13 (7–23) kcal/kg, respectively. Mortality occurred more frequently among patients who were in a fasting state ( p =0.004). No differences in energy or protein intake were observed between the groups. According to the logistic regression analysis, fasting state at the time of AKI diagnosis increased the risk of death (OR 3.53, p =0.03), with an area under the curve of 0.67. Moreover, 34% of patients were in a state of moderate-severe wasting at the time of AKI diagnosis, but this event was not associated with mortality. Conclusions In our prospective cohort of patients with AKI, we found that a high proportion of patients experienced wasting, nutrient intake was below the recommended levels, and one-third of the patients were in a fasting state at the time of AKI diagnosis; these features were strongly associated with increased in-hospital mortality rates.

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