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Abstract
BackgroundFor chronic kidney disease (CKD) patients, management of nutritional status is critical for delaying progression to end-stage renal disease. The purpose of this study is to provide the basis for personalized nutritional intervention in pre-dialysis patients by comparing the foods contributing to nutrients intake, nutritional status and potential dietary inflammation of CKD patients according to the diabetes mellitus (DM) comorbidity and CKD stage.MethodsTwo hundred fifty-six outpatients referred to the Department of Nephrology at SNUH from Feb 2016 to Jan 2017 were included. Subjects on dialysis and those who had undergone kidney transplantation were excluded. Bioelectrical impedance analysis (BIA), subjective global assessment (SGA), dietary intake, and biochemical parameters were collected. Subjects were classified into 4 groups according to DM comorbidity (DM or Non-DM) and CKD stage (Early or Late) by kidney function. Two-way analysis of variance and multinomial logistic regression analysis were performed for statistical analysis.ResultsTotal number of malnourished patients was 31 (12.1%), and all of them were moderately malnourished according to SGA. The body mass index (BMI) of the DM-CKD group was significantly higher than the Non-DM-CKD group. The contribution of whole grains and legumes to protein intake in the DM-CKD group was greater than that in the Non-DM-CKD group. The DM- Early-CKD group consumed more whole grains and legumes compared with the Non-DM-Early-CKD group. The subjects in the lowest tertile for protein intake had lower phase angle, SGA score and serum albumin levels than those in the highest tertile. The potential for diet-induced inflammation did not differ among the groups.ConclusionsSignificant differences in intakes of whole grains and legumes between CKD patients with or without DM were observed. Since contribution of whole grains and legumes to phosphorus and potassium intake were significant, advice regarding whole grains and legumes may be needed in DM-CKD patients if phosphorus and potassium intake levels should be controlled. The nutritional status determined by BIA, SGA and serum albumin was found to be different depending on the protein intake. Understanding the characteristics of food sources can provide a basis for individualized nutritional intervention for CKD patients depending on the presence of diabetes.
Highlights
For chronic kidney disease (CKD) patients, management of nutritional status is critical for delaying progression to end-stage renal disease
Since contribution of whole grains and legumes to phosphorus and potassium intake were significant, advice regarding whole grains and legumes may be needed in diabetes mellitus (DM)-CKD patients if phosphorus and potassium intake levels should be controlled
The nutritional status determined by Bioelectrical impedance analysis (BIA), subjective global assessment (SGA) and serum albumin was found to be different depending on the protein intake
Summary
For chronic kidney disease (CKD) patients, management of nutritional status is critical for delaying progression to end-stage renal disease. For CKD patients with diabetes, controlling blood glucose levels and maintaining optimal nutritional status are critical for the prevention of progression to the end stage renal disease (ESRD) because diabetes mellitus (DM) can accelerate the progression of CKD [2]. Bioelectrical impedance analysis (BIA) and subjective global assessment (SGA) are used as screening tools to assess the nutritional status of CKD patients. Malnutrition is a common condition in dialysis patients and DM comorbidity affects protein-energy wasting status [6]. Phase angle (PhA), body mass index (BMI), and percent body fat measured by BIA were related to nutritional status according to the SGA classification [7]. Excess extracellular fluid (ECF) is common and can be a predictor of CVD morbidity in ESRD patients [8, 9]
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