SELF REPORTED POOR APPETITE SHOWS INDEPENDENT ASSOCIATION WITH CARDIAC DYSFUNCTION AND CARDIOVASCULAR DISEASE IN CHRONIC KIDNEY DISEASE

Anorexia is common in patients with chronic kidney disease (CKD) and predicts poor survival. We performed this prospective study with an aim to determine factors associated with poor appetite in patients with stage 3-5 CKD. A cohort of 296 stage 3-5 CKD patients (168 men and 128 women) was invited to grade their own appetite in the recent one month on a scale from 1 to 4 (namely, very good, good, fair, and poor appetite, respectively). In addition, these patients underwent echocardiographic examination and other clinical and biochemical assessments. The mean age of these patients was 60±10 years with an average estimated glomerular filtration rate (eGFR) of 32±14ml/min per 1.73m2. Appetite was graded as very good, good, fair and poor in 61, 114, 110 and 11 patients, respectively. Patients who graded their own appetite as poor were noted to have the lowest eGFR (P=0.047), lowest left ventricular (LV) ejection fraction (p=0.006), lowest midwall fractional shortening (p=0.004), highest prevalence of diabetes (P=0.19) and symptomatic atherosclerotic vascular disease (AVD) (P=0.003). Notably, serum albumin in the poor appetite group did not differ from the other 3 groups. In the multiple logistic regression analysis, LV ejection fraction [Odds ratio (OR), 0.92, 95% confidence intervals (CI), 0.86–0.98; P=0.014] and symptomatic AVD [OR, 4.56, 95% CI, 1.16–17.96; P=0.03] showed independent association with poor appetite and their significance appeared to outweigh that of eGFR [OR, 0.94, 95% CI, 0.89–1.00; P=0.058].In conclusion, poor appetite in CKD patients is frequently associated with the presence of cardiovascular co-morbidity and cardiac dysfunction. These data suggest that a simple subjective scoring of appetite may be useful in identifying CKD patients with underlying cardiac disease. Further study is needed to determine the exact mechanism linking cardiac disease and anorexia in CKD patients