The association of frailty and malnutrition with dietary intake and gastrointestinal symptoms in people with kidney failure: 2-year prospective study.

BACKGROUND: Frailty and malnutrition are both associated with worsening morbidity and mortality and become more prevalent in the elderly and as kidney function declines. Anorexia and reduced oral intake are common features of both frailty and malnutrition. However, there is sparse data evaluating the impact of other gastrointestinal symptoms, such as taste changes, on rates of frailty and malnutrition in people with kidney failure. The aim of this study is to describe the prevalence of frailty and malnutrition and their association with dietary intake and nutrition-related symptoms in people with kidney failure.

METHODS: This observational study recruited people with kidney failure who were commencing Conservative Kidney Management or elderly people (aged >75 years) newly commenced on dialysis from three renal units. Participants underwent assessments of frailty, nutritional status, dietary intake and gastrointestinal symptom burden when they attended clinic appointments, approximately every six months.

RESULTS: Of the 85 participants, 57% were assessed as being frail and 33% were assessed as being malnourished. Participants assessed as frail reported more gastrointestinal symptoms (3 versus 2, p<0.001) that were more severe (1.75 vs 1.0, p<0.001) compared to non-frail participants. Being malnourished was associated with a 5 times higher chance of being frail (OR 5.8, 95% CI 1.5, 21.8, p=0.015) and having more severe symptoms was associated with a 2 times higher chance (OR 2.8, 95% CI 1.1, 7.0, p=0.026) of being frail. In addition to experiencing more gastrointestinal symptoms, that were more severe, participants who were malnourished consumed significantly less energy (1234kcal vs 1400kcal, p=0.01) and protein (51g vs 74g, p<0.001).

CONCLUSIONS: Frailty and malnutrition are common and are associated with a higher gastrointestinal symptom burden and poorer dietary intake. Future research is needed to determine effective interventions targeting frailty and malnutrition, including nutrition-related symptoms and optimal protein intake.