24-h Urine Collection: A Relevant Tool in CKD Nutrition Evaluation.

Moustafa Abdel-Nabey,Jean-Jacques Boffa,Michel Daudon,Emmanuel Letavernier,Marine Livrozet,Vincent Frochot,Martin Flamant,Camille Saint-Jacques,Jean-Philippe Haymann

doi:10.3390/nu12092615

Abstract

Dietary management is a cornerstone of Chronic Kidney Disease (CKD) monitoring, and dietary surveys often difficult to perform. We studied in a CKD patient cohort with two years follow-up, whether validated 24-h urine ionogram would be a relevant tool for diet evaluation and compliance. We included 404 non-dialysis CKD patients, with three evaluations, including repeated measurements of fractional renal creatinine clearance and 24-h urine collection. Completeness of the 24-h urine collection, assessed by daily urine creatinine excretion extrapolated from fractional creatinine clearance, was 64.6%, 75.5%, and 78.2% at the first, second, and third visits, respectively. One hundred sixty-eight patients (41.6%) had three complete collections, with a measured glomerular filtration of 42.3 mL/min/1.73 m2 at baseline and prevalence of anemia and secondary hyperparathyroidism of 13.9% and 26.2%, respectively, increasing during follow-up to 15% and 31.5% (p < 0.001 and p < 0.001). The urine analysis showed at baseline a urine volume of above 2 L/day, and estimated sodium and protein intake within targets in 51.6% and 40.3% of cases, which improved during follow-up only for protein (to 45.9%, p < 0.0001). Our data suggest that a 24-h urine ionogram is an interesting, reliable tool in CKD patients for dietary monitoring to achieve target recommendation noteworthy salt and protein intake.

Highlights

Chronic kidney disease (CKD) is a public health problem worldwide with prevalence between 8%and 16% [1] responsible for significant cardiovascular morbidity and mortality [2,3]
261 patients (65%) had a valid 24-h urine collection defined as a difference below 30%
This is the first report evaluating in a non-end stage Chronic Kidney Disease (CKD) cohort the reliability and interest of the 24-urine ionogram data in order to monitor dietary targets during a two year follow-up

Summary

Introduction

Chronic kidney disease (CKD) is a public health problem worldwide with prevalence between 8%and 16% [1] responsible for significant cardiovascular morbidity and mortality [2,3]. Low protein diet prescribed to non-end-stage renal disease patients could–in addition to preserving renal function–be an important strategy to prevent disturbed gut microbiota reported in CKD patients and decrease levels of uremic toxins (such as indoxyl sulfate) and cardiovascular risk factors [11,12,13]. Diet inquiries are expensive and time-consuming, and monitoring remains uncertain due to the lack of specific tools Though available surveys, such as the Dietary Sodium Restriction Questionnaire [16,17], are prone to favor the understanding of patients on low sodium diet, their accuracy in evaluating sodium intake may be questionable in some cases. The use of a relevant and easy-to-perform tool to quantify salt and diet protein intake “at the bedside” and at lower cost is most welcome

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Conclusion