Abstract
Studies on the effect of dietary protein intake (DPI) on chronic kidney disease (CKD) progression, along with the potential hazard of protein-energy wasting (PEW), are scarce. We evaluated the association between DPI and kidney function both cross-sectionally and longitudinally, particularly emphasizing the role of PEW, in a large-scale, observational, multicenter, prospective study. We enrolled 1572 patients with non-dialysis CKD between 2011 and 2016. CKD progression was defined by a >50% estimated glomerular filtration rate (eGFR) decrease, serum creatinine doubling, or dialysis initiation. A Cox proportional hazard regression analysis was conducted. During the mean follow-up period of 41.6 months, CKD progression was observed in 296 patients. Cross-sectionally, increased DPI was significantly associated with increased eGFR. Similarly, increased DPI tertile was significantly associated with increased renal survival in a Kaplan–Meier curve analysis. In the multivariate Cox proportional hazard regression analysis, the statistical significance of the DPI tertile group in CKD progression was lost when PEW-related variables were added as covariates. In penalized spline curve analysis, the adjusted odds ratio of PEW significantly increased as DPI decreased. DPI, per se was not a major determinant of CKD progression. An intimate association between reduced DPI and PEW may be a more important predictor of CKD progression than DPI.
Highlights
Since most uremic toxins are waste products of protein metabolism [1], a low-protein diet (LPD)may be effective in alleviating uremic symptoms in patients with advanced chronic kidney diseaseNutrients 2019, 11, 121; doi:10.3390/nu11010121 www.mdpi.com/journal/nutrients (CKD) [2,3]
We evaluated the association between dietary protein intake (DPI) and kidney function both cross-sectionally
We evaluated the association between DPI and kidney function both and longitudinally and found that DPI per se was not a major determinant of CKD progression; cross-sectionally and longitudinally and found that DPI per se was not a major determinant of CKD
Summary
Since most uremic toxins are waste products of protein metabolism [1], a low-protein diet (LPD)may be effective in alleviating uremic symptoms in patients with advanced chronic kidney diseaseNutrients 2019, 11, 121; doi:10.3390/nu11010121 www.mdpi.com/journal/nutrients (CKD) [2,3]. Because early dialysis initiation did not show survival benefits in patients with CKD [4], LPD as a conservative approach to delay dialysis initiation has been revisited [5,6]. An LPD delays dialysis initiation and may slow CKD progression by the reduction of renal hyperfiltration [7,8,9]. LPDs have not been frequently used [10] because the cornerstone trial, the Modification of Diet in Renal Disease (MDRD) study, failed to demonstrate a clear benefit of LPDs on slowing CKD progression [11], and long-term follow-up of the MDRD study has warned that. The term protein energy wasting (PEW) was suggested to describe this syndromic uremic malnutrition [13]. Subsequent studies after the MDRD study have shown renoprotective effects of LPDs in patients with
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