Association between energy intake and prognosis in Chronic Kidney Disease (CKD) stages 3-5: an ambispective cohort...

The association between dietary energy intake and disease outcomes in CKD 3-5 remains unclear. This study explored this relationship in Southern Chinese CKD 3-5 patients.

This retrospective cohort study included 234 CKD 3-5 patients from the Self-Management Program for Patients with Chronic Kidney Disease (SMP-CKD) database. The endpoint was a composite of sustained decline of at least 30% in estimated glomerular filtration rate (eGFR), the initiation of kidney replacement therapy, or all-cause mortality. The main variable was energy intake. Kaplan-Meier analysis, restricted cubic splines, and Cox regression models were performed to assess the association.

85 (36.3%) individuals reached the endpoint with a median follow-up of 33 months. The median age was 56.0 (46.3, 63.3) years, and 121 (51.7%) were male. The association between energy intake and the endpoint in CKD 3-5 patients showed a U-shaped relationship. We reclassified patients according to energy intake: Group 1 (<24.6 kcal/kg/d), Group 2 (24.6-29.5 kcal/kg/d), and Group 3 (>29.5 kcal/kg/d). Compared to Group 2, Group 3 (HR = 3.0; 95%CI, 1.118-7.993, p = 0.029) and Group 1 (HR = 2.5; 95%CI, 1.068-5.966, p = 0.035) had a higher risk of reaching the endpoint. Subgroup analysis showed no significant interaction except for age, with a consistent U-shaped relationship in those ≤ 60 years.

High and low energy intake are significantly associated with an increased risk of adverse outcomes in non-dialysis CKD 3-5 patients. An energy intake of 24.6-29.5 kcal/kg/day may be optimal to reduce the risk of poor health outcomes.