PD397 - ASSOCIATION BETWEEN ENERGY DOSE AND CLINICAL OUTCOMES IN HOSPITALIZED PATIENTS WITH CHRONIC KIDNEY DISEASE RECEIVING EXCLUSIVE PARENTERAL NUTRITION: A RETROSPECTIVE COHORT STUDY
PD397
ASSOCIATION BETWEEN ENERGY DOSE AND CLINICAL OUTCOMES IN HOSPITALIZED PATIENTS WITH CHRONIC KIDNEY DISEASE RECEIVING EXCLUSIVE PARENTERAL NUTRITION: A RETROSPECTIVE COHORT STUDY
H. Kabasawa1,*, H. Yoshida2, A. Shintani2, R. Hamamoto3, M. Tani3, S. Kamoshita3, M. Hosojima1
1Aizubange Center for Nephrology and Clinical Nutrition, Fukushima Medical University, Fukushima, 2Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, 3Medical Affairs Department, Research and Development Center, Otsuka Pharmaceutical Factory, Tokyo, Japan
Rationale: This study aimed to evaluate the optimal energy dose for hospitalized patients with chronic kidney disease (CKD) receiving exclusive parenteral nutrition.
Methods: We analyzed a Japanese administrative claims database to identify patients with CKD admitted to acute-care hospitals between 2012 and 2023 who received exclusive parenteral nutrition for ≥10 days. The mean prescribed parenteral energy dose (kcal/kg/day) was calculated from days 4–10 of parenteral nutrition. We evaluated associations between energy dose and outcomes (in-hospital mortality, length of hospital stay, activities of daily living, and readmission) using Cox proportional hazards, logistic regression, and Fine–Gray models with multivariable adjustments. We then applied restricted cubic splines to model nonlinear associations and plotted linear predictors against prescribed energy dose (0–30 kcal/kg/day) in 5.0-kcal/kg/day increments.
Results: Among 38,577 patients, 84.3% were aged ≥70 years, 35.4% were female, 29.1% had a body mass index <18.5 kg/m², and 26.2% were receiving maintenance dialysis. The mean prescribed energy dose during days 4–10 was 9.8 kcal/kg/day. The log relative hazard of in-hospital mortality and the log relative subdistribution hazard for length of stay decreased with increasing prescribed energy doses up to 10 kcal/kg/day, plateaued between 10 and 15 kcal/kg/day, and increased between 15 and 30 kcal/kg/day, forming a U-shaped association. No significant associations were observed for activities of daily living or readmission.
Conclusion: For hospitalized patients with CKD receiving exclusive parenteral nutrition, an energy dose of 10–15 kcal/kg/day may be appropriate.
Disclosure of Interest: H. Kabasawa: None declared, H. Yoshida: None declared, A. Shintani: None declared, R. Hamamoto Other: employee of Otsuka Pharmaceutical Factory, Inc., M. Tani Other: employee of Otsuka Pharmaceutical Factory, Inc., S. Kamoshita Other: employee of Otsuka Pharmaceutical Factory, Inc., M. Hosojima Consultant for: advisory fees from Otsuka Pharmaceutical Factory, Inc.