Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. May 19, 2025; 15(5): 102539
Published online May 19, 2025. doi: 10.5498/wjp.v15.i5.102539
Analysis of influencing factors on the nutritional status of non-dialysis elderly patients with chronic kidney disease and depression
Zi-Yu Song, Ni Li, Hong-Bao Liu
Zi-Yu Song, Ni Li, Hong-Bao Liu, Department of Nephrology, Tangdu Hospital, The Fourth Military Medical University (Air Force Medical University), Xi’an 710038, Shaanxi Province, China
Co-first authors: Zi-Yu Song and Ni Li.
Author contributions: Song ZY designed the research, wrote the first draft of the manuscript, conducted the analysis, and provided guidance for the research; Song ZY, Li N, and Liu HB contributed to conceiving the research and analyzing the data; All authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethic Committee of Tangdu Hospital, The Fourth Military Medical University (Air Force Medical University) (No. K202404-14).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Bao Liu, PhD, Doctor, Department of Nephrology, Tangdu Hospital, The Fourth Military Medical University (Air Force Medical University), No. 1 Xinsi Road, Baqiao District, Xi’an 710038, Shaanxi Province, China. xjsnlhb@fmmu.edu.cn
Received: January 10, 2025
Revised: March 7, 2025
Accepted: April 8, 2025
Published online: May 19, 2025
Processing time: 110 Days and 0.9 Hours
Abstract
BACKGROUND

The assessment of nutritional status in non-dialysis elderly patients with chronic kidney disease (CKD) and comorbid depression is clinically important. Determining key determinants of nutritional status in this population significantly improves nutritional management strategies and assists these patients overcome the disease.

AIM

To investigate the factors influencing the nutritional status of non-dialysis elderly patients with CKD and comorbid depression.

METHODS

This study retrospectively collected the clinical data of 182 non-dialysis elderly patients with CKD and comorbid depression admitted at Tangdu Hospital, Air Force Medical University, from January 2022 to June 2023. The participants were categorized based on the presence of malnutrition into the nutritionally normal group (n = 97) and the malnutrition group (n = 85). The clinical data of the two groups were subjected to unifactorial and multifactorial regression to analyze the factors influencing malnutrition among the participants. Data included sex, age, body mass index (BMI), percentage body fat, basal metabolic rate (BMR), blood urea nitrogen (BUN), creatinine (Cr), albumin (Alb), hemoglobin (Hb), pre-albumin (PA), patient-generated subjective global assessment, and Patient Health Questionnaire-9 (PHQ-9) score to identify depressive symptoms. After admitting the patients to the hospital, 5 mL of peripheral serum was withdrawn, the centrifuge was operated at 3500 rpm/minute with a centrifugal radius of 10 cm for 10 minutes, serum was collected, and serum Alb, Hb, PA, BUN, and Cr levels were detected using a fully automatic biochemical analyzer. The results were assessed using Statistical Package for the Social Sciences version 21.0 for conducting technical analyses. Metric data are presented as the mean ± standard error of the mean and replaced using the t-test. Count data are expressed as case counts and percentages and were replaced using the χ2 test. Effective factors were modeled using logistic return modeling.

RESULTS

BMI, BMR, and serum Alb, Hb, PA, and Cr levels were lower in the nutritionally normal group than in the malnutrition group. Furthermore, BUN levels, PHQ-9 scores, and the percentage of anxiety symptoms were greater in the nutritionally normal group than in the normal nutrition group, with statistically significant differences (P < 0.05). Multiple factorial interpretations revealed anxiety and serum Alb, Hb, and PA levels as factors influencing the nutritional status of non-dialysis elderly patients with CKD and depression (P < 0.05).

CONCLUSION

Serum Alb, Hb, PA levels, and anxiety symptoms are all factors influencing malnutrition in non-dialysis elderly patients with CKD and depression; hence, clinical interventions can be targeted to patients with the above characteristics.

Keywords: Chronic kidney disease; Depression; Malnutrition; Non-dialysis; Elderly patients

Core Tip: Malnutrition is prevalent among non-dialysis elderly patients with chronic kidney disease (CKD) and comorbid depression, which exacerbates disease progression, impairs prognosis, and undermines clinical outcomes. This study enrolled 182 non-dialysis elderly patients with CKD and depression to investigate nutritional status and analyze influencing factors. Results demonstrated that serum albumin (Alb), hemoglobin (Hb), and pre-albumin (PA) levels and anxiety symptoms independently influenced malnutrition risk in this cohort. Specifically, increased serum Alb, Hb, and PA levels were protective factors, whereas the presence of anxiety symptoms was a risk factor. Clinically, regular monitoring of serum Alb, Hb, and PA levels should be prioritized to guide timely nutritional interventions. Moreover, close observation and immediate psychological support should be provided for patients presenting with anxiety symptoms to effectively address their mental health needs.