Admission kidney function is a strong predictor for the response to nutritional support in patients at nutritional risk.

Bargetzi, Annika; Emmenegger, Nora; Wildisen, Simone; Nickler, Manuela; Bargetzi, Laura; Hersberger, Lara; Segerer, Stephan; Kaegi-Braun, Nina; Tribolet, Pascal; Gomes, Filomena; Hoess, Claus; Pavlicek, Vojtech; Bilz, Stefan; Sigrist, Sarah; Brändle, Michael; Henzen, Christoph; Thomann, Robert; Rutishauser, Jonas; Aujesky, Drahomir; Rodondi, Nicolas; ... (2021). Admission kidney function is a strong predictor for the response to nutritional support in patients at nutritional risk. Clinical nutrition, 40(5), pp. 2762-2771. Elsevier 10.1016/j.clnu.2021.03.013

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Patients with chronic kidney disease (CKD) are at substantial risk of malnutrition, which negatively affects clinical outcomes. We investigated the association of kidney function assessed at hospital admission and effectiveness of nutritional support in hospitalized medical patients at risk of malnutrition.


This is a secondary analysis of an investigator-initiated, randomized-controlled, Swiss multicenter trial (EFFORT) that compared individualised nutritional support with usual hospital food on clinical outcomes. We compared effects of nutritional support on mortality in subgroups of patients stratified according to kidney function at the time of hospital admission (estimated glomerular filtration rates [eGFR] <15, 15-29, 30-59, 60-89 and ≥ 90 ml/min/1.73 m2).


We included 1943 of 2028 patients (96%) from the original trial with known admission creatinine levels. Admission eGFR was a strong predictor for the beneficial effects of nutritional support in regard to lowering of 30-day mortality. Patients with an eGFR <15, 15-29 and 30-59 had the strongest mortality benefit (odds ratios [95%CI] of 0.24 [0.05 to 1.25], 0.37 [0.14 to 0.95] and 0.39 [0.21 to 0.75], respectively), while patients with less severe impairment in kidney function had a less pronounced mortality benefits (p for interaction 0.001). A similar stepwise association of kidney function and response to nutritional support was found also for other secondary outcomes.


In medical inpatients at nutritional risk, admission kidney function was a strong predictor for the response to nutritional therapy. Initial kidney function may help to individualize nutritional support in the future by identification of patients with most clinical benefit.


Registered under Identifier no. NCT02517476.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Aujesky, Drahomir; Rodondi, Nicolas and Stanga, Zeno


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services






[4] Swiss National Science Foundation




Andrea Flükiger-Flückiger

Date Deposited:

07 May 2021 16:05

Last Modified:

17 Mar 2022 00:25

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Chronic kidney disease Clinical outcomes Kidney function Malnutrition Nutritional support Outcome Randomized trial Renal function




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