Abstract
The aim of this research was to develop a simple equation to evaluate dietary protein intake (DPI) in patients with stage 3 chronic kidney disease (CKD) using the blood urea nitrogen (BUN)/serum creatinine (SCr) ratio (BUN/SCr). In a prospective cohort of 136 inpatients with stage 3 CKD from 2 centres, the estimated dietary protein intake (DPI) was calculated using Maroni's formula after the patients implemented a 7day protein-restricted diet. We developed estimation equations based on BUN/SCr and the spot urinary urea nitrogen (UUN)/urinary creatinine (UCr) ratio (UUN/UCr) in combination with sex and body mass index (BMI). These equations were then internally and externally validated. The following candidate parameters were derived from univariate regression analysis for 5 established models: sex, BMI, BUN/SCr, UUN and UUN/UCr. Sex and BMI were included in all models after variable evaluation using multiple regression analysis. UUN, UUN/UCr and BUN/SCr were included in model 3, model 4 and model 5, respectively. Both internal and external validation indicated that model 5 resulted in the lowest values for bias and root mean square error and the highest P30 compared with model 3 and model 4. Therefore, the model 5 equation, DPI = - 5.18 (- 14.49 if the patient is female) + 1.89 × BMI + 1.38 × BUN/SCr, was selected because of the higher correlation (r = 0.498) between the estimated DPI and predicted DPI. The DPI equation developed using BUN/SCr, sex and BMI may be used to estimate protein intake for patients with stage 3 CKD. Chinese Clinical Trial Registry Center (ChiCTR-ROC-17011363). Registered on 11 May 2017, Retrospectively registered, http://www.chictr.org.cn/index.aspx .
Highlights
A simple, effective and convenient method to assess dietary protein intake (DPI) for chronic kidney disease (CKD) patients is urgently needed in clinical practice
Patient preference, and adherence are key points in the application and practical implementation of dietary protein restriction, regular, simple, and easy monitoring of DPI is essential for ongoing nutritional education, improvements in compliance and the evaluation of the potential risk of protein-energy wasting in patients on a low-protein diet (LPD) [4]
CKD was diagnosed by the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines [12]
Summary
A simple, effective and convenient method to assess dietary protein intake (DPI) for chronic kidney disease (CKD) patients is urgently needed in clinical practice. Patient preference, and adherence are key points in the application and practical implementation of dietary protein restriction, regular, simple, and easy monitoring of DPI is essential for ongoing nutritional education, improvements in compliance and the evaluation of the potential risk of protein-energy wasting in patients on a low-protein diet (LPD) [4]. Several methods, such as 24-hour dietary recall, diet records and diaries (with or without dietary interviews), urea dynamic calculated protein intake, and food frequency questionnaires, have been used to assess DPI for patients with CKD [5, 6]. A simple, effective and convenient method to assess DPI for CKD patients is urgently needed
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