Nutritional status, mortality and kidney disease progression in older patients with advanced chronic kidney disease

Background & aims Malnutrition is common in older patients with advanced chronic kidney disease (CKD). This study investigates whether nutritional status is associated with 1-year mortality and CKD progression in this population. Methods Patients ≥65 years (eGFR 20–10 mL/min/1.73 m²) were included from the observational prospective DIALOGICA study. Patients were classified as being at risk of malnutrition with a Mini Nutritional Assessment Short-Form (MNA-SF) score ≤11 and as having a normal nutritional status with scores ≥12. One-year mortality was defined as death (all-cause) occurring within 1-year and CKD progression as eGFR decline <10 mL/min/1.73 m² and/or initiation of kidney replacement therapy (KRT) within 1-year from inclusion. Associations between nutritional status and mortality were assessed using multivariable Cox proportional hazards models, associations between nutritional status and CKD progression were assessed using multivariable Fine–Gray models. Results 610 patients were included (mean age 76.6 ± 5.8 years, mean eGFR 14.8 ± 3.1 mL/min/1.73 m²), with 160 patients (26.2%) at risk of malnutrition. During follow-up, 55 patients (9.0%) died and 154 patients (25.2%) experienced CKD progression. Patients at risk of malnutrition had significantly higher 1-year mortality risk (adjusted hazard ratio or HR 1.88, 95% CI 1.08; 3.25) but not significantly higher CKD progression risk (adjusted subdistributional-HR 1.06, 95% CI 0.71; 1.59). Conclusion Older patients with advanced CKD and malnutrition risk face significantly higher 1-year mortality risk but not higher CKD progression risk. These findings may help identify vulnerable patients who are at high risk of early mortality who may benefit from dietary interventions.