Association between self‐reported appetite and clinical outcomes of peritoneal dialysis patients: Findings from a low middle‐income country. Issue 5 (10th March 2021)

• Record Type: Journal Article
• Authors: Boonyakrai, Chanchana; Kanjanabuch, Talerngsak; Puapatanakul, Pongpratch; Halue, Guttiga; Johnson, David W.; Lorvinitnun, Pichet; Tangjittrong, Kittisak; Kittiskulnam, Piyawan; Pongpirul, Krit; Bieber, Brian; Tungsanga, Kriang
• Is Part Of: Nephrology. Volume 26:Issue 5(2021)
• Page Start: 454
• Page End: 462
• Publication Date: 2021-03-10
• Subjects: appetite -- patient‐reported outcomes -- peritoneal dialysis -- peritoneal dialysis outcomes and practice patterns study (PDOPPS); Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.13859
• Languages: English
• ISSNs: 1320-5358

Abstract

Abstract: Aim: Patient‐reported outcome measures (PROM) has gained international recognition as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand the associations between patient‐reported appetite and clinical outcomes. Methods: In the Thailand Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), 690 of 848 randomly selected PD patients from 22 facilities reported their appetite by using the short form (three items) of the Appetite and Diet Assessment Tool (ADAT), between 2016 and 2018. In this questionnaire, the patients rated their appetite as well as a change in appetite over time. Cox proportional hazards model regression was used to estimating associations between self‐reported appetite and clinical outcomes, including mortality, haemodialysis (HD) transfer and peritonitis. Results: Half of the PD patients reported a good appetite, whereas 34% and 16% reported fair and poor appetites, respectively. Poor appetite was more prevalent among female, diabetic, congestive heart failure, older age and patients who had worse nutritional indicators, including lower time‐averaged serum albumin and serum creatinine concentrations, as well as a higher proportions of hypokalaemia and severe hypoalbuminemia (serum albumin <3 g/dl). After adjusting for age, sex, comorbidities, and PD vintage, poor appetite was associated with increased risks of peritonitis (adjusted hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.14–2.62), HD transfer (adjusted HR 2.25, 95% CI 1.24–4.10) and all‐cause mortality (adjusted HR 1.60, 95% CI 1.08–2.39) compared to patients with good appetite. Conclusion: Patient‐reported poor appetite was independently associated with higher risks of peritonitis, HD transfer and all‐cause mortality. This warrants further investigation to identify effective interventions. SUMMARY AT A GLANCE: This study shows an association between self‐reported appetite loss and clinical outcomes in patients undergoing peritoneal dialysis. Patient‐reported poor appetite was independently associated with higher risks of peritonitis, HD transfer, and all‐cause mortality.