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

Acute kidney injury (AKI) in hospitalized patients is linked to high morbidity and mortality. Nutritional status may be a modifiable factor influencing outcomes, but its role in critically ill patients with AKI remains unclear.

In this single-center prospective study, we evaluated hospitalized adults with AKI who underwent baseline nutritional assessments, including dietary intake, anthropometric data, and subjective global assessment. Nutritional data were collected through direct evaluation or clinical records for those receiving enteral or parenteral nutrition. Logistic regression identified variables associated with in-hospital mortality.

A total of 102 patients were included (mean age 53 ± 17 years; 73% male). Sepsis and hypovolemia were the leading causes of AKI; 50% had stage 3 AKI and 40% required renal replacement therapy. The in-hospital mortality rate was 36%. At AKI diagnosis, 26% were fasting; 53% received oral nutrition, 14% enteral nutrition, and 7% parenteral nutrition. Median protein and energy intakes were 0.45 (0.2-0.7) g/kg and 13 (7-23) kcal/kg, respectively. Mortality was significantly higher among fasting patients (P = .004). No significant differences in energy or protein intake were found between survivors and nonsurvivors. Logistic regression showed that fasting at AKI diagnosis increased the risk of death (odds ratio = 3.53, P = .03; AUC = 0.67). Additionally, 34% had moderate to severe wasting, but this was not associated with increased mortality.

In this cohort of AKI patients, nutrient intake was frequently below recommended levels, and one-third was fasting at diagnosis. Fasting was independently associated with increased in-hospital mortality, highlighting the need for early nutritional assessment and intervention in this population.