Handgrip strength (HGS) is suggested as an indirect assessment of nutritional status in chronic kidney disease (CKD) patients, but evidence is limited for non-dialysis-dependent CKD (NDD-CKD) patients. This cross-sectional study included 404 patients from the Phase II KoreaN Cohort Study for Outcome in Patients With CKD. HGS, measured twice in each hand, was the exposure, and malnutrition status was defined by a malnutrition–inflammation score (MIS) of 6 or higher. A logistic regression analysis adjusted for age, sex, diabetes mellitus (DM), hypertension, CKD stages, smoking, overhydration, education, and income status was used to assess malnutrition risk. The predictability of HGS for malnutrition was evaluated using the area under the curve (AUC). Patients with lower HGS were older, had a higher prevalence of DM, and lower estimated glomerular filtration rate. Higher HGS was significantly associated with lower malnutrition risk after adjustment (per 1 standard deviation increase, adjusted odds ratio, 0.47 [0.30–0.75]). Subgroup analyses showed no significant interaction between HGS and malnutrition risk across age, sex, DM, and CKD stage. HGS showed fair predictability for malnutrition in men (AUC 0.64 [0.46–0.83]) and women (AUC 0.71 [0.55–0.86]). In conclusion, HGS is a useful diagnostic indicator of malnutrition in NDD-CKD patients.

Background: Chronic kidney disease (CKD) patients are hospitalized for various conditions. Hospitalization increases the readmission rate and mortality rate, seriously deteriorating patients’ quality of life. Consequently, it is crucial to analyze the reasons for hospitalization in CKD patients from a broader perspective according to CKD grade. Methods: This is a prospective cohort study of CKD patients entitled the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease (KNOW-CKD). A total of 2,238 patients were examined, and the reasons for hospitalization were classified into 16 disease categories. The incidence rate ratio (IRR) according to CKD stage was compared using negative bimodal regression analysis. Results: The all-cause hospitalization incidence was 184.96 per 1,000 person-years. The most common reason for hospitalization was circulatory system disease, followed by infection and digestive system disease. Among hospitalizations for acute kidney injury, endocrine-nutrition-metabolic–related illness, blood-related disease, and diseases of the nervous system and sensory organs, IRR increased as CKD grade advanced. The incidence of ophthalmologic surgery during hospitalization increased according to the CKD stage. The IRR of KNOW-CKD patients was 6.19 (95% confidence interval, 5.92–6.48; p < 0.001) compared with the general population. Conclusion: This in-depth analysis of hospitalizations among CKD patients confirmed that CKD patients were hospitalized for various reasons, such as metabolic, ophthalmic, and hematologic diseases. Early detection and intervention regarding causative diseases of CKD are important to reduce the hospitalization burden and improve patients’ quality of life.

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic kidney disorder with multiple cyst formation that progresses to chronic kidney disease (CKD) and end-stage kidney disease. Plant-based diets have attracted considerable attention because they may prevent CKD development. This study investigated whether adherence to a plant-based diet is associated with kidney function in patients with ADPKD. The overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) were calculated using dietary intake data. Among 106 ADPKD patients, 37 (34.91%) were classified as having advanced CKD (eGFR < 60 mL/min/1.73 m²). The overall PDI and hPDI were lower, but the uPDI was higher in patients with advanced CKD than in those with early CKD. The hPDI was negatively correlated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. Moreover, the hPDI was inversely associated with advanced CKD [odds ratio (OR): 0.117 (95% confidence interval (CI): 0.039–0.351), p < 0.001], and the uPDI was positively associated with advanced CKD [OR: 8.450 (95% CI: 2.810–25.409), p < 0.001]. The findings of the current study demonstrate that greater adherence to a healthful plant-based diet is associated with improved kidney function in ADPKD patients.

Key Points: Lower bone mineral density was associated with a higher risk of fracture, irrespective of eGFR. At a similar bone mineral density, the fracture risk was higher with lower eGFR, more prominently for hip fractures than for vertebral fractures. The higher risk of fracture associated with lower eGFR was more pronounced in individuals with poor static balance. Background: Although both lower bone mineral density (BMD) and impaired kidney function are well-established risk factors for fracture, large-scale studies evaluating their effects and interaction on fracture, particularly site-specific fractures including vertebra and hip, are still limited. Methods: The main study population included female participants aged 66 years who underwent BMD assessment through dual-energy x-ray absorptiometry through the Korean National Screening Program between 2010 and 2016. BMD was categorized as normal, osteopenia, and osteoporosis on the basis of T -score. Kidney function was classified as eGFR ≥60, 45–59, and <45 ml/min per 1.73 m ² . Primary outcome was any fracture, including vertebral, hip, and other fractures, defined using International Classification of Diseases, Tenth Revision codes. Subgroup analysis was performed by physical performance, including the single-leg stance test. Results: Among 551,548 participants included in the main study population, 80,514 developed any fracture over a median follow-up of 8.2 (interquartile range, 6.7–10.0) years. The prevalence of osteoporosis was 36%, and those with lower BMD showed higher eGFR and lower body mass index. Lower BMD was associated with a higher risk of any fracture, irrespective of eGFR, with nonsignificant interaction ( P for interaction = 0.54). Among participants with normal BMD, those with eGFR <45 ml/min per 1.73 m ² showed a greater risk of hip fracture than those with normal eGFR (adjusted hazard ratio, 2.44 [1.88–3.18]), whereas vertebral fracture risks were similar across different eGFR categories at a given BMD status. Furthermore, a higher fracture risk with lower eGFR was more pronounced in women with poor static balance assessed by the single-leg stance test than in those with normal static balance. Conclusions: In postmenopausal women, lower BMD was associated with a higher fracture risk, irrespective of eGFR. However, at any given BMD, lower eGFR was associated with a greater risk for hip fracture, but not for vertebral fracture.

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome represents the progressive interplay among metabolic dysfunction, kidney impairment, and cardiovascular disease (CVD), ultimately contributing to higher mortality. We investigated how changes across CKM stages correlate with subsequent all-cause mortality in a nationwide population-based cohort. Methods: We analyzed data from 2,812,170 adults aged ≥20 years who underwent two general health screenings four years apart through the Korean National Health Insurance Service, with CKM stages classified according to clinical criteria reflecting progressive metabolic, kidney, and cardiovascular risk. Stage-specific CKM stage change (improve, sustain, or progress) and its association with all-cause mortality were evaluated using multivariable Cox regression analysis, adjusted for clinicodemographic variables. Results: During the four-year exposure assessment period, 674,465 adults (24%) experienced CKM stage progress, 1,802,489 (64%) sustained their CKM stage, and 335,216 (12%) improved. Over a subsequent 6.4-year follow-up, CKM stage progress was significantly associated with an higher risk of all-cause mortality [adjusted HR 1.38 (1.36–1.41)], whereas CKM stage improvement was associated with a lower risk [adjusted HR 0.93 (0.90–0.95)]. Notably, even early-stage progression (from stage 0 to stage 1) was linked to a higher mortality risk [adjusted HR 1.08 (1.01–1.15)], with a stepwise higher risk observed with progression to more advanced follow-up CKM stages. The association between CKM stage progress and mortality was more pronounced in older adults. Conclusion: Worsening of CKM stage is associated with higher all-cause mortality from early to advanced stages, whereas CKM stage improvement is associated with lower mortality risk. These findings provide epidemiologic real-world evidence supporting the importance of monitoring and intervening on CKM progression across its full spectrum to lower long-term mortality risk.

Protein-energy wasting (PEW) is a strong indicator of adverse outcomes such as all-cause death and cardiovascular events. Although this association has been established in dialysis patients, it has not been clearly demonstrated in those with non-dialysis-dependent chronic kidney disease (NDD-CKD). This study aimed to evaluate the association between PEW and all-cause death or cardiovascular events in patients with NDD-CKD. We investigated the association between PEW and adverse outcomes in patients with NDD-CKD through a prospective cohort study of 1,847 patients (median follow-up: 6.94 years). The definition of PEW followed the International Society of Renal Nutrition and Metabolism criteria: serum albumin <3.8 g/dL, body mass index <23.0 kg/m2, skeletal muscle mass <19.7 kg in women, <26.9 kg in men, and protein intake <0.6 g/kg/day. During follow-up, 129 deaths and 264 composite outcomes (all-cause death or cardiovascular events) occurred. In Cox regression analysis, all-cause death and composite outcomes were significantly increased in patients with two or more PEW parameters. All-cause death was significantly increased in patients with two PEW parameters (hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.61-4.08; p < 0.001) or ≥3 PEW parameters (HR, 3.78; 95% CI, 1.81-7.89; p < 0.001). Composite outcomes were also significantly increased in patients with two PEW parameters (HR, 2.16; 95% CI, 1.51-3.11; p < 0.001) or ≥3 PEW parameters (HR, 2.30; 95% CI, 1.30-4.07; p = 0.004). PEW was a strong indicator of all-cause death and composite outcomes among NDD-CKD patients.