P0918LONGITUDINAL TRAJECTORIES OF NUTRITIONAL PARAMETERS WITH ORAL NUTRITIONAL SUPPLEMENT USE AMONG NON-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS
Bibliographic record
Abstract
Abstract Background and Aims Malnutrition and protein-energy wasting are complications of advanced CKD associated with increased risk of mortality and morbidity. In the province of British Columbia, Canada, a Nutritional Supplement Policy stewarded by renal dietitians guides prescription of oral nutritional supplements (ONS). To date, there have been a lack of studies assessing the effects of ONS among non-dialysis CKD patients (CKD-ND). The aim of the study was to assess longitudinal trajectories of nutrition, inflammation and associated biochemical parameters following initiation of ONS among CKD-ND patients. Method In this retrospective cohort study of adult CKD-ND patients who initiated follow-up at multidisciplinary Kidney Care Clinics during 2013-2015, we used radar charts to examine longitudinal trajectories of nutritional, inflammation and related parameters over 2 years, among patients who had at least one ONS prescription and who had available lab data for the following 8 parameters within any given time interval: body mass index (BMI), serum albumin, bicarbonate, phosphate, parathyroid hormone, ferritin, neutrophil-to-lymphocyte ratio (NLR) and haemoglobin. Mean values of each parameter were plotted at 6-month intervals from the first prescription of ONS, up to 29 months. Results There were 963, 692, 569, 481, 425 patients with available data during the intervals at month 0-5, 6-11, 12-17, 18-23 and 24-29 following the first ONS prescription, respectively. Mean serum albumin increased from a mean of 37 to 40 g/L over the 29-month period after ONS initiation, while mean NLR declined from 4.5 to 3.6 (Figure). Mean serum ferritin also declined slightly from 293 to 261 µg/L at 3 months and remained stable thereafter. There were small fluctuations in mean BMI (range 24.5 to 25.1 kg/m2), bicarbonate (range 24 to 25 mmol/L), PTH (range 15.5 to 18.0 pmol/L). Mean haemoglobin rose from 108 g/L in the first interval to 116 g/L in the last interval. Mean serum phosphate changed minimally from 1.4 to 1.3 mmol/L. Conclusion Among CKD-ND patients who had at least one ONS prescription, serum albumin increased, while there was a decrease in inflammation parameters (NLR and ferritin), and other variables had small fluctuations over the 2+ year follow-up. Future analyses will include multivariable-adjusted models to assess the associations of ONS treatment with nutritional variables and with clinical outcomes, including progression to end-stage kidney disease.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".