Pub Date : 2026-01-01Epub Date: 2025-08-05DOI: 10.1053/j.jrn.2025.07.009
Raíssa Antunes Pereira PhD , Marle dos Santos Alvarenga PhD , Paula Costa Teixeira PhD , Laila Santos de Andrade PhD , Renata Rodrigues Teixeira MS , Elke Stedefeldt PhD , Lilian Cuppari PhD
Objective
This study aimed to evaluate a behavioral intervention conducted with nondialyzed overweight women with chronic kidney disease (CKD) by describing their eating behaviors.
Design and Methods
This prospective, mixed-method, noncontrolled clinical trial used a behavioral nondiet approach with 15 multisession group interventions for dietary management among 33 overweight women with CKD (age = 62.0 [54.0-67.5] years; body mass index = 32.8 [30.5-38.6] kg/m2; estimated glomerular filtration rate = 28.0 [20.0-31.5] mL/min/1.73 m3). Thematic content analysis was performed using qualitative data from focus groups conducted before and after the intervention. Combined quantitative and qualitative methods were triangulated using data from the Intuitive Eating Scale-2.
Results
Eight categories emerged from the preintervention (factors that influence eating and living, diet culture, feelings of ambivalence and/or stagnation, and understanding one's limitations) and postintervention periods (appreciation for the different approach, awakening self-confidence, eating attunement, and discovering a new way to eat). The Intuitive Eating Scale-2 factors concur with the preintervention and postintervention categories, contributing to the transition from a less to more intuitive eating profile.
Conclusion
Behavioral intervention raised positive eating experiences that aligned with a more intuitive way of eating. Patients felt more empowered to accept and manage the disease. These results may contribute to changes in the adherence paradigm in nondialysis CKD.
{"title":"Eating Behavior Intervention of Overweight Women With Chronic Kidney Disease: A Qualitative Analysis","authors":"Raíssa Antunes Pereira PhD , Marle dos Santos Alvarenga PhD , Paula Costa Teixeira PhD , Laila Santos de Andrade PhD , Renata Rodrigues Teixeira MS , Elke Stedefeldt PhD , Lilian Cuppari PhD","doi":"10.1053/j.jrn.2025.07.009","DOIUrl":"10.1053/j.jrn.2025.07.009","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate a behavioral intervention conducted with nondialyzed overweight women with chronic kidney disease (CKD) by describing their eating behaviors.</div></div><div><h3>Design and Methods</h3><div>This prospective, mixed-method, noncontrolled clinical trial used a behavioral nondiet approach with 15 multisession group interventions for dietary management among 33 overweight women with CKD (age = 62.0 [54.0-67.5] years; body mass index = 32.8 [30.5-38.6] kg/m<sup>2</sup>; estimated glomerular filtration rate = 28.0 [20.0-31.5] mL/min/1.73 m<sup>3</sup>). Thematic content analysis was performed using qualitative data from focus groups conducted before and after the intervention. Combined quantitative and qualitative methods were triangulated using data from the Intuitive Eating Scale-2.</div></div><div><h3>Results</h3><div>Eight categories emerged from the preintervention (factors that influence eating and living, diet culture, feelings of ambivalence and/or stagnation, and understanding one's limitations) and postintervention periods (appreciation for the different approach, awakening self-confidence, eating attunement, and discovering a new way to eat). The Intuitive Eating Scale-2 factors concur with the preintervention and postintervention categories, contributing to the transition from a less to more intuitive eating profile.</div></div><div><h3>Conclusion</h3><div>Behavioral intervention raised positive eating experiences that aligned with a more intuitive way of eating. Patients felt more empowered to accept and manage the disease. These results may contribute to changes in the adherence paradigm in nondialysis CKD.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"36 1","pages":"Pages 90-98"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-08-05DOI: 10.1053/j.jrn.2025.05.008
Syed Danial Kamal MBBS, Amir Reza Akbari MBBS, Benyamin Alam MBBS
{"title":"The Role of Smoking in Dietary and Potassium Balance Among Hemodialysis Patients","authors":"Syed Danial Kamal MBBS, Amir Reza Akbari MBBS, Benyamin Alam MBBS","doi":"10.1053/j.jrn.2025.05.008","DOIUrl":"10.1053/j.jrn.2025.05.008","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"36 1","pages":"Page 153"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-09-25DOI: 10.1053/j.jrn.2025.09.003
Yue Li MD , Zhiling Wang MD , Chunmei Wang BSc , Zhengsheng Rao MD , Wenqian Huo MD , Keqin Zhang MD, PhD
Objective
Patients with end-stage renal disease are predisposed to low muscle mass (LMM) and myosteatosis. This study aimed to investigate the predictive value of LMM and myosteatosis, as assessed by computed tomography (CT), in predicting clinical outcomes following kidney transplantation.
Methods
A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted to retrieve relevant English-language studies. Eligible studies reported on the associations of LMM and myosteatosis, determined via CT scan, with clinical outcomes in kidney transplant recipients. The primary outcomes were patient and graft survival.
Results
A total of 13 studies involving 2,764 kidney transplant recipients were included. The pooled prevalence of LMM was 28% (95% confidence interval [CI]: 0.16–0.40, I2 = 98%), while that of myosteatosis was 24% (95% CI: 0.16–0.33, I2 = 96%). LMM was significantly associated with an increased risk of patient mortality (hazard ratio [HR] = 2.08, 95% CI: 1.62–2.67, I2 = 13%) and graft loss (HR = 1.43, 95% CI: 1.03–1.98, I2 = 0%). Furthermore, LMM was linked to an increased incidence of hospital readmissions within 1 month (odds ratio = 2.05, 95% CI: 1.41–3.00, I2 = 0%) and 3 months (odds ratio = 1.78, 95% CI: 1.25–2.52, I2 = 0%). Recipients with myosteatosis also demonstrated a significantly increased risk of mortality (HR = 1.82, 95% CI: 1.24–2.67, I2 = 7%) and graft loss (HR = 1.99, 95% CI: 1.21–3.26, I2 = 0%).
Conclusion
LMM and myosteatosis are prevalent in kidney transplant recipients and significantly impact prognosis. Comprehensive utilization of preoperative CT-derived muscle mass and density data may facilitate early risk stratification and inform clinical decision-making.
{"title":"Associations of Low Muscle Mass and Myosteatosis With Kidney Transplant Outcomes: A Systematic Review and Meta-Analysis","authors":"Yue Li MD , Zhiling Wang MD , Chunmei Wang BSc , Zhengsheng Rao MD , Wenqian Huo MD , Keqin Zhang MD, PhD","doi":"10.1053/j.jrn.2025.09.003","DOIUrl":"10.1053/j.jrn.2025.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with end-stage renal disease are predisposed to low muscle mass (LMM) and myosteatosis. This study aimed to investigate the predictive value of LMM and myosteatosis, as assessed by computed tomography (CT), in predicting clinical outcomes following kidney transplantation.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted to retrieve relevant English-language studies. Eligible studies reported on the associations of LMM and myosteatosis, determined via CT scan, with clinical outcomes in kidney transplant recipients. The primary outcomes were patient and graft survival.</div></div><div><h3>Results</h3><div>A total of 13 studies involving 2,764 kidney transplant recipients were included. The pooled prevalence of LMM was 28% (95% confidence interval [CI]: 0.16–0.40, I<sup>2</sup> = 98%), while that of myosteatosis was 24% (95% CI: 0.16–0.33, I<sup>2</sup> = 96%). LMM was significantly associated with an increased risk of patient mortality (hazard ratio [HR] = 2.08, 95% CI: 1.62–2.67, I<sup>2</sup> = 13%) and graft loss (HR = 1.43, 95% CI: 1.03–1.98, I<sup>2</sup> = 0%). Furthermore, LMM was linked to an increased incidence of hospital readmissions within 1 month (odds ratio = 2.05, 95% CI: 1.41–3.00, I<sup>2</sup> = 0%) and 3 months (odds ratio = 1.78, 95% CI: 1.25–2.52, I<sup>2</sup> = 0%). Recipients with myosteatosis also demonstrated a significantly increased risk of mortality (HR = 1.82, 95% CI: 1.24–2.67, I<sup>2</sup> = 7%) and graft loss (HR = 1.99, 95% CI: 1.21–3.26, I<sup>2</sup> = 0%).</div></div><div><h3>Conclusion</h3><div>LMM and myosteatosis are prevalent in kidney transplant recipients and significantly impact prognosis. Comprehensive utilization of preoperative CT-derived muscle mass and density data may facilitate early risk stratification and inform clinical decision-making.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"36 1","pages":"Pages 4-12"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-01DOI: 10.1053/j.jrn.2025.11.005
Jill Hoyt RDN, CD, FNKF
{"title":"CRN: Message From the Chair","authors":"Jill Hoyt RDN, CD, FNKF","doi":"10.1053/j.jrn.2025.11.005","DOIUrl":"10.1053/j.jrn.2025.11.005","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"36 1","pages":"Page 158"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145672958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-09-12DOI: 10.1053/j.jrn.2025.09.001
Ayşe Şeker MD , Beyza Temel MD
Objectives
This study investigated serum selenium and zinc levels across three groups of chronic kidney disease patients and examined their associations with inflammation, nutrition parameters, and erythropoiesis-stimulating agent response.
Methods
This retrospective cross-sectional study included 298 patients (98 hemodialysis (HD), 92 peritoneal dialysis (PD), and 108 predialysis). We analyzed demographic data andlaboratory parameters, including selenium, zinc, hemoglobin, and erythropoietin resistance index (ERI). Multivariable linear regression analyses evaluated independent associations between trace elements and ERI while controlling for potential confounders.
Results
Selenium levels were significantly lower in PD patients compared to HD and predialysis patients, while zinc levels were highest in HD patients. In PD patients, selenium demonstrated a significant negative correlation with ERI (r = −0.32, P = .009), which remained significant in multivariable regression analysis (β = −0.13, P = .008) after adjusting for confounders. Partial correlation analysis revealed significant positive associations between urine output and selenium levels in PD (rp = .29, P = .005) and predialysis patients (rp = .21, P = .028). Albumin showed positive correlations with selenium across all groups.
Conclusions
Selenium and zinc levels vary significantly across patient groups. Selenium levels showed a significant independent negative correlation with ERI in PD patients, suggesting its potential involvement in erythropoiesis. The association between selenium and nutritional markers suggests that nutritional status plays a crucial role in maintaining adequate trace element levels. Residual renal function appears to significantly influence selenium levels, particularly in PD patients.
目的：本研究调查了三组慢性肾病患者的血清硒和锌水平，并研究了它们与炎症、营养参数和促红细胞生成剂（ESA）反应的关系。方法：回顾性横断面研究纳入298例患者（血液透析98例，腹膜透析92例，透析前108例）。我们分析了人口统计学数据、实验室参数，包括硒、锌、血红蛋白和红细胞生成素抵抗指数（ERI）。多变量线性回归分析评估了微量元素和ERI之间的独立关联，同时控制了潜在的混杂因素。结果：腹膜透析患者的硒水平明显低于血液透析和透析前患者，而锌水平在血液透析患者中最高。在腹膜透析患者中，硒与ERI呈显著负相关（r = -0.32, p = 0.009），在校正混杂因素后，在多变量回归分析中仍然显著（β = -0.13, p = 0.008）。偏相关分析显示，腹膜透析患者（rp = 0.29, p = 0.005）和透析前患者（rp = 0.21, p = 0.028）尿量与硒水平呈显著正相关。白蛋白与硒呈显著正相关。结论：不同患者组硒和锌水平差异显著。硒水平与腹膜透析患者ERI呈显著的独立负相关，提示其可能参与红细胞生成。硒与营养指标之间的关系表明，营养状况在维持足够的微量元素水平方面起着至关重要的作用。残余肾功能似乎显著影响硒水平，特别是在腹膜透析患者中。
{"title":"The Impact of Selenium and Zinc Levels on Erythropoiesis-Stimulating Agent Response in Chronic Kidney Disease Patients: A Comparative Study of Predialysis, Hemodialysis, and Peritoneal Dialysis Patients","authors":"Ayşe Şeker MD , Beyza Temel MD","doi":"10.1053/j.jrn.2025.09.001","DOIUrl":"10.1053/j.jrn.2025.09.001","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigated serum selenium and zinc levels across three groups of chronic kidney disease patients and examined their associations with inflammation, nutrition parameters, and erythropoiesis-stimulating agent response.</div></div><div><h3>Methods</h3><div>This retrospective cross-sectional study included 298 patients (98 hemodialysis (HD), 92 peritoneal dialysis (PD), and 108 predialysis). We analyzed demographic data andlaboratory parameters, including selenium, zinc, hemoglobin, and erythropoietin resistance index (ERI). Multivariable linear regression analyses evaluated independent associations between trace elements and ERI while controlling for potential confounders.</div></div><div><h3>Results</h3><div>Selenium levels were significantly lower in PD patients compared to HD and predialysis patients, while zinc levels were highest in HD patients. In PD patients, selenium demonstrated a significant negative correlation with ERI (r = −0.32, <em>P</em> = .009), which remained significant in multivariable regression analysis (β = −0.13, <em>P</em> = .008) after adjusting for confounders. Partial correlation analysis revealed significant positive associations between urine output and selenium levels in PD (r<sub>p</sub> = .29, <em>P</em> = .005) and predialysis patients (r<sub>p</sub> = .21, <em>P</em> = .028). Albumin showed positive correlations with selenium across all groups.</div></div><div><h3>Conclusions</h3><div>Selenium and zinc levels vary significantly across patient groups. Selenium levels showed a significant independent negative correlation with ERI in PD patients, suggesting its potential involvement in erythropoiesis. The association between selenium and nutritional markers suggests that nutritional status plays a crucial role in maintaining adequate trace element levels. Residual renal function appears to significantly influence selenium levels, particularly in PD patients.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"36 1","pages":"Pages 144-152"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2024-06-22DOI: 10.1053/j.jrn.2024.06.006
Vanessa Gomes Brandão Rodrigues MD , Whesley Tanor Silva MSc , Ana Caiane Rocha da Silva MSc , Patrícia Cardoso Campos MSc , Luciana Martins de Mello Santos MSc , Ana Cristina Rodrigues Lacerda PhD , Frederico Lopes Alves MD , Emílio Henrique Barroso Maciel MD , Maria Cecília Sales Mendes Prates MD , Henrique Silveira Costa PhD , Vanessa Pereira de Lima PhD , Vanessa Amaral Mendonça PhD , Pedro Henrique Scheidt Figueiredo PhD
Objective
To assess the association of residual diuresis with sarcopenia in patients with chronic kidney disease on hemodialysis.
Methods
Through a cross-sectional study, patients on hemodialysis were subjected to a Dual-Energy Radiologic Absorption examination to record muscle mass. Based on the volume of urine collected in 24 hours, patients were classified as anuric (diuresis ≤100 mL/day) or nonanuric (diuresis > 100 mL/day). Functional performance was evaluated by Short Physical Performance Battery (SPPB) and muscle strength by handgrip strength and 5-repetition sit-to-stand test. The association between the absence of residual urine and the presence of sarcopenia, low SPPB, and low muscle strength was analyzed using a binary logistic regression model.
Results
Ninety-two patients, with a mean age of 54.4 years (95% confidence interval [CI] 51.3-57.4) and with a mean diuresis volume of 476.3 mL/day (95% CI 320.4-632.2) were evaluated (48 anuric and 44 nonanuric). Anuric patients had a 2.77 (95% CI 1.14-6.73) times greater probability of sarcopenia and had a 3.55 (1.14-11.0) times greater probability of low SPPB regardless of gender, age, and time on dialysis. Gender was the other associated variable for the presence of sarcopenia, with males having a 3.30 (95% CI 1.34-8.13) times higher risk. There were no associations with muscle strength.
Conclusion
The absence of residual diuresis in patients on hemodialysis is associated with a higher risk of sarcopenia and low functional performance.
{"title":"Relationship Between Residual Diuresis and Sarcopenia in Patients on Hemodialysis","authors":"Vanessa Gomes Brandão Rodrigues MD , Whesley Tanor Silva MSc , Ana Caiane Rocha da Silva MSc , Patrícia Cardoso Campos MSc , Luciana Martins de Mello Santos MSc , Ana Cristina Rodrigues Lacerda PhD , Frederico Lopes Alves MD , Emílio Henrique Barroso Maciel MD , Maria Cecília Sales Mendes Prates MD , Henrique Silveira Costa PhD , Vanessa Pereira de Lima PhD , Vanessa Amaral Mendonça PhD , Pedro Henrique Scheidt Figueiredo PhD","doi":"10.1053/j.jrn.2024.06.006","DOIUrl":"10.1053/j.jrn.2024.06.006","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the association of residual diuresis with sarcopenia in patients with chronic kidney disease on hemodialysis.</div></div><div><h3>Methods</h3><div>Through a cross-sectional study, patients on hemodialysis were subjected to a Dual-Energy Radiologic Absorption examination to record muscle mass. Based on the volume of urine collected in 24 hours, patients were classified as anuric (diuresis ≤100 mL/day) or nonanuric (diuresis > 100 mL/day). Functional performance was evaluated by Short Physical Performance Battery (SPPB) and muscle strength by handgrip strength and 5-repetition sit-to-stand test. The association between the absence of residual urine and the presence of sarcopenia, low SPPB, and low muscle strength was analyzed using a binary logistic regression model.</div></div><div><h3>Results</h3><div>Ninety-two patients, with a mean age of 54.4 years (95% confidence interval [CI] 51.3-57.4) and with a mean diuresis volume of 476.3 mL/day (95% CI 320.4-632.2) were evaluated (48 anuric and 44 nonanuric). Anuric patients had a 2.77 (95% CI 1.14-6.73) times greater probability of sarcopenia and had a 3.55 (1.14-11.0) times greater probability of low SPPB regardless of gender, age, and time on dialysis. Gender was the other associated variable for the presence of sarcopenia, with males having a 3.30 (95% CI 1.34-8.13) times higher risk. There were no associations with muscle strength.</div></div><div><h3>Conclusion</h3><div>The absence of residual diuresis in patients on hemodialysis is associated with a higher risk of sarcopenia and low functional performance.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"36 1","pages":"Pages 112-120"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-08-05DOI: 10.1053/j.jrn.2025.06.011
Tingfei He MM
{"title":"Letter to the Editor: Effects of Ketoanalogue Supplements on Patients Receiving Continuous Ambulatory Peritoneal Dialysis: A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Study","authors":"Tingfei He MM","doi":"10.1053/j.jrn.2025.06.011","DOIUrl":"10.1053/j.jrn.2025.06.011","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"36 1","pages":"Pages 155-156"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-01DOI: 10.1053/j.jrn.2025.09.006
Yue Shi , Hangyu Duan , Jing Liu , Xiujie Shi , Mingming Zhao , Yongfei Fang , Yu Zhang
Objective(s)
Malnutrition is a significant factor associated with adverse outcomes in various diseases. However, the prevalence of malnutrition among critically ill patients with acute kidney injury (AKI) and its impact on outcomes have not been thoroughly investigated. The purpose of this study was to investigate the prevalence and prognostic significance of malnutrition in critically ill patients with AKI.
Methods
Critically ill patients with AKI were selected from the Medical Information Mart for Intensive Care IV through a retrospective cohort study. The nutritional status of these patients was assessed using the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT). Cox proportional hazard model, Kaplan-Meier analysis, and limited cubic spline were used to evaluate the association between malnutrition risk and 28-day mortality. In addition, logistic regression, Cox regression, and linear regression were used to assess the correlation between malnutrition risk and in-hospital mortality, 90-day mortality, and hospital length of stay, respectively.
Results
Of the 1,129 patients enrolled, 49.6%, 80.0%, and 57.7% were found to have moderate to severe malnutrition based on PNI, GNRI, and CONUT scores, respectively. Higher risk of malnutrition was associated with lower hemoglobin, lymphocytes, serum albumin, total cholesterol, higher creatinine, blood urea nitrogen, sepsis organ failure assessment score, simplified acute physiology score II, higher mortality, and longer hospital stay. Among the patients, 215 (19.04%) died within 28 days of intensive care unit admission. Malnutrition was significantly associated with 28-day mortality risk compared with good nutrition (adjusted hazard ratio for severe malnutrition: PNI:HR 1.57, 95% confidence interval [CI] 1.15-2.14; GNRI:HR 1.62, 95% CI 1.01-2.55; CONUT:HR 2.51, 95% CI 1.31-4.80). These nutritional measures further enhanced the predictive accuracy of 28-day mortality, with the CONUT score demonstrating the strongest association. Furthermore, logistic regression, Cox regression, and linear regression models, respectively, revealed that malnutrition risk was significantly associated with in-hospital mortality, 90-day mortality, and hospital length of stay.
Conclusions
Malnutrition is prevalent among critically ill patients with AKI and significantly correlates with 28-day mortality, in-hospital mortality, 90-day mortality, and hospital length of stay. Further research is necessary to evaluate the impact of malnutrition screening and nutritional interventions on improving adverse outcomes.
背景：营养不良是导致各种疾病不良结局的重要因素。然而，急性肾损伤（AKI）危重患者营养不良的患病率及其对预后的影响尚未得到彻底调查。本研究的目的是探讨急性肾损伤危重患者营养不良的发生率及预后意义。方法：通过回顾性队列研究，从重症监护医疗信息市场Ⅳ中选择AKI危重患者。采用预后营养指数（PNI）、老年营养风险指数（GNRI）和控制营养状况（CONUT）对这些患者的营养状况进行评估。采用Cox比例风险模型、Kaplan-Meier分析和有限三次样条法评价营养不良风险与28天死亡率之间的关系。此外，利用logistic回归、Cox回归和线性回归分别评估营养不良风险与住院死亡率、90天死亡率和住院时间之间的相关性。结果：在纳入的1129例患者中，根据PNI、GNRI和CONUT评分，分别有49.6%、80.0%和57.7%的患者存在中度至重度营养不良。较高的营养不良风险与较低的血红蛋白、淋巴细胞、血清白蛋白、总胆固醇、较高的肌酐、BUN、SOFA、SAPS II、较高的死亡率和较长的住院时间相关。其中215例（19.04%）患者在入住ICU后28天内死亡。与良好营养相比，营养不良与28天死亡风险显著相关（严重营养不良的校正风险比：PNI:HR 1.57, 95% CI 1.15-2.14; GNRI:HR 1.62, 95% CI 1.01-2.55; CONUT:HR 2.51, 95% CI 1.31-4.80）。这些营养指标进一步提高了28天死亡率的预测准确性，其中CONUT评分显示出最强的相关性。此外，logistic回归、Cox回归和线性回归模型分别显示，营养不良风险与住院死亡率、90天死亡率和住院时间显著相关。结论：营养不良在AKI危重患者中普遍存在，并与28天死亡率、住院死亡率、90天死亡率和住院时间显著相关。需要进一步的研究来评估营养不良筛查和营养干预对改善不良后果的影响。
{"title":"Prevalence and Prognostic Significance of Malnutrition in Critically Ill Patients With Acute Kidney Injury","authors":"Yue Shi , Hangyu Duan , Jing Liu , Xiujie Shi , Mingming Zhao , Yongfei Fang , Yu Zhang","doi":"10.1053/j.jrn.2025.09.006","DOIUrl":"10.1053/j.jrn.2025.09.006","url":null,"abstract":"<div><h3>Objective(s)</h3><div>Malnutrition is a significant factor associated with adverse outcomes in various diseases. However, the prevalence of malnutrition among critically ill patients with acute kidney injury (AKI) and its impact on outcomes have not been thoroughly investigated. The purpose of this study was to investigate the prevalence and prognostic significance of malnutrition in critically ill patients with AKI.</div></div><div><h3>Methods</h3><div>Critically ill patients with AKI were selected from the Medical Information Mart for Intensive Care IV through a retrospective cohort study. The nutritional status of these patients was assessed using the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT). Cox proportional hazard model, Kaplan-Meier analysis, and limited cubic spline were used to evaluate the association between malnutrition risk and 28-day mortality. In addition, logistic regression, Cox regression, and linear regression were used to assess the correlation between malnutrition risk and in-hospital mortality, 90-day mortality, and hospital length of stay, respectively.</div></div><div><h3>Results</h3><div>Of the 1,129 patients enrolled, 49.6%, 80.0%, and 57.7% were found to have moderate to severe malnutrition based on PNI, GNRI, and CONUT scores, respectively. Higher risk of malnutrition was associated with lower hemoglobin, lymphocytes, serum albumin, total cholesterol, higher creatinine, blood urea nitrogen, sepsis organ failure assessment score, simplified acute physiology score II, higher mortality, and longer hospital stay. Among the patients, 215 (19.04%) died within 28 days of intensive care unit admission. Malnutrition was significantly associated with 28-day mortality risk compared with good nutrition (adjusted hazard ratio for severe malnutrition: PNI:HR 1.57, 95% confidence interval [CI] 1.15-2.14; GNRI:HR 1.62, 95% CI 1.01-2.55; CONUT:HR 2.51, 95% CI 1.31-4.80). These nutritional measures further enhanced the predictive accuracy of 28-day mortality, with the CONUT score demonstrating the strongest association. Furthermore, logistic regression, Cox regression, and linear regression models, respectively, revealed that malnutrition risk was significantly associated with in-hospital mortality, 90-day mortality, and hospital length of stay.</div></div><div><h3>Conclusions</h3><div>Malnutrition is prevalent among critically ill patients with AKI and significantly correlates with 28-day mortality, in-hospital mortality, 90-day mortality, and hospital length of stay. Further research is necessary to evaluate the impact of malnutrition screening and nutritional interventions on improving adverse outcomes.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"36 1","pages":"Pages 58-69"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-06-28DOI: 10.1053/j.jrn.2025.06.006
Gabriela V. Proaño MS, RDN , Constantina Papoutsakis PhD, RD , Lindsay Woodcock MS, RDN, LDN , Erin Lamers-Johnson MS, RD , Lisa Moloney PhD, RDN , Jenica K. Abram MPH, RDN, LDN , Alison Steiber PhD, RDN , Joyce Marcley Vergili EdD, RD, CSR, CDN, CDCES, FAND , Xingya Ma MS , Ming Ji PhD , Kathryn Kelley MPH , Alexa Steiber MPH , Larissa Myaskovsky PhD , Elizabeth Yakes Jimenez PhD, RDN
Objectives
This study aimed to (1) assess implementation of selected recommendations from the current clinical practice guideline for nutrition care in chronic kidney disease by registered dietitian nutritionists (RDNs) and (2) evaluate impact of a comprehensive guideline training on RDN practice.
Methods
We evaluated implementation of recommendations for subjective global assessment and intake of dietary protein, energy, phosphorus, and oral nutrition supplements (ONS). RDNs were randomized to receive standard knowledge-based guideline training or comprehensive training (standard training plus implementation training). Outcomes included congruence (consistency) between documented practice and guideline recommendations and RDN-reported guideline acceptability, adoption, and adaptation. Outcomes were descriptively analyzed, and odds of congruent care were compared by training group using multilevel logistic regression.
Results
Twenty-five RDNs from 28 US clinics documented nutrition care for 565 hemodialysis patients over 1,175 visits. Provided care was congruent or fully congruent with the guideline for almost all identified visits covering intake of protein (100% of visits), phosphorus (95%), and energy (95%) and most visits discussing ONS (69%). Most subjective global assessment components were rarely documented (<7% of visits) except for weight/weight change. Top RDN-reported acceptability factors were potential for positive impact on patients, strength of the evidence-base, and alignment with their current practice and skillsets. They noted more leadership level support was required to fully implement some recommendations (e.g., ONS). The comprehensive training did not improve odds of congruent care compared with standard training.
Conclusion
RDN documented practice was congruent with most selected guideline recommendations. A multilevel approach may improve implementation of recommendations.
{"title":"Implementation of an Evidence-Based Renal Nutrition Practice Guideline: The AUGmeNt Study","authors":"Gabriela V. Proaño MS, RDN , Constantina Papoutsakis PhD, RD , Lindsay Woodcock MS, RDN, LDN , Erin Lamers-Johnson MS, RD , Lisa Moloney PhD, RDN , Jenica K. Abram MPH, RDN, LDN , Alison Steiber PhD, RDN , Joyce Marcley Vergili EdD, RD, CSR, CDN, CDCES, FAND , Xingya Ma MS , Ming Ji PhD , Kathryn Kelley MPH , Alexa Steiber MPH , Larissa Myaskovsky PhD , Elizabeth Yakes Jimenez PhD, RDN","doi":"10.1053/j.jrn.2025.06.006","DOIUrl":"10.1053/j.jrn.2025.06.006","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to (1) assess implementation of selected recommendations from the current clinical practice guideline for nutrition care in chronic kidney disease by registered dietitian nutritionists (RDNs) and (2) evaluate impact of a comprehensive guideline training on RDN practice.</div></div><div><h3>Methods</h3><div>We evaluated implementation of recommendations for subjective global assessment and intake of dietary protein, energy, phosphorus, and oral nutrition supplements (ONS). RDNs were randomized to receive standard knowledge-based guideline training or comprehensive training (standard training plus implementation training). Outcomes included congruence (consistency) between documented practice and guideline recommendations and RDN-reported guideline acceptability, adoption, and adaptation. Outcomes were descriptively analyzed, and odds of congruent care were compared by training group using multilevel logistic regression.</div></div><div><h3>Results</h3><div>Twenty-five RDNs from 28 US clinics documented nutrition care for 565 hemodialysis patients over 1,175 visits. Provided care was congruent or fully congruent with the guideline for almost all identified visits covering intake of protein (100% of visits), phosphorus (95%), and energy (95%) and most visits discussing ONS (69%). Most subjective global assessment components were rarely documented (<7% of visits) except for weight/weight change. Top RDN-reported acceptability factors were potential for positive impact on patients, strength of the evidence-base, and alignment with their current practice and skillsets. They noted more leadership level support was required to fully implement some recommendations (e.g., ONS). The comprehensive training did not improve odds of congruent care compared with standard training.</div></div><div><h3>Conclusion</h3><div>RDN documented practice was congruent with most selected guideline recommendations. A multilevel approach may improve implementation of recommendations.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"36 1","pages":"Pages 70-82"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号