Abstract
Chronic kidney disease (CKD) is becoming increasingly widespread in the world. Slowing its progression means to prevent uremic complications and improve quality of life of patients. Currently, a low-protein diet (LPD) is one of the tools most used in renal conservative therapy but a possible risk connected to LPD is protein-energy wasting. The aim of this study is evaluate the possible correlation between LPD and malnutrition onset. We enrolled 41 CKD patients, stages IIIb/IV according to K-DIGO guidelines, who followed for 6 weeks a diet with controlled protein intake (recommended dietary allowance 0.7 g per kilogram Ideal Body Weight per day of protein). Our patients showed a significant decrease of serum albumin values after 6 weeks of LDP (T2) compared with baseline values (T0) (P=0.039), whereas C-reactive protein increased significantly (T0 versus T2; P=0.131). From body composition analysis, a significant impairment of fat-free mass percentage at the end of the study was demonstrated (T0 versus T2; P=0.0489), probably related to total body water increase. The muscular mass, body cell mass and body cell mass index are significantly decreased after 6 weeks of LDP (T2). The phase angle is significantly reduced at the end of the study compared with basal values (T0 versus T2; P=0.0001, and T1 versus T2; P=0.0015). This study indicated that LPD slows down the progression of kidney disease but worsens patients' nutritional state.
Highlights
Chronic kidney disease (CKD) represents a major problem of public health and its evolution in end-stage renal disease requires renal replacement therapy (hemodialysis, peritoneal dialysis (PD) or transplantation)
We observed a significant decrease of serum albumin values after 6 weeks of low-protein diet (LPD) (T2) compared with baseline values (T0) (P = 0.039)
C-reactive protein (CRP) at the end of the study increased significantly compared with start point values (T0 versus T2; P = 0.0131)
Summary
Chronic kidney disease (CKD) represents a major problem of public health and its evolution in end-stage renal disease requires renal replacement therapy (hemodialysis, peritoneal dialysis (PD) or transplantation). In the last 100 years, CKD patient management of restriction of dietary daily protein intake, has a central role.[8] During the 1960s, for the first time, Giovannetti and Maggiore[9] set the stage for diet therapy treatments currently used in CKD patients. In CKD patients, protein-energy wasting is a frequent condition, characterized by low serum levels of albumin or transthyretin, sarcopenia and weight loss. Protein-energy wasting is strongly related to mortality in CKD patients.[12] A 10-year cohort study in 206 hemodialysis patients showed that serum albumin level was a stronger predictor of mortality, more than inflammatory markers or intima-media thickness of the common carotid artery.[13] In CKD population, surrogates of over-nutrition, for instance obesity or hyperlipidemia, seem to be associated with increased survival; this phenomenon is acknowledged as 'reverse epidemiology'.14. E-GST was already considered a potential biomarker of blood toxicity and adequacy of the dialytic treatments in nephropathic patients.[15,16,17]
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