Association of a Low-Protein Diet With Slower Progression of CKD.

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Version: Final published version
License: CC BY-NC-ND 4.0
Serval ID
serval:BIB_52202A2B4648
Type
Article: article from journal or magazin.
Collection
Publications
Title
Association of a Low-Protein Diet With Slower Progression of CKD.
Journal
Kidney international reports
Author(s)
Metzger M., Yuan W.L., Haymann J.P., Flamant M., Houillier P., Thervet E., Boffa J.J., Vrtovsnik F., Froissart M., Bankir L., Fouque D., Stengel B.
ISSN
2468-0249 (Electronic)
ISSN-L
2468-0249
Publication state
Published
Issued date
01/2018
Peer-reviewed
Oui
Volume
3
Number
1
Pages
105-114
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Reducing protein intake is recommended for slowing chronic kidney disease (CKD) progression, but assessment of its true effectiveness is sparse.
Using the Maroni formula, we assessed dietary protein intake (DPI) from 24-hour urinary urea excretion in 1594 patients (67% men and 33% women) with CKD, 784 of whom also had 7-day food records. Cause-specific hazard ratios (HRs) and 95% confidence intervals for the competing risks of DPI-associated end-stage renal disease (ESRD) or death were estimated in 1412 patients with baseline glomerular filtration rate ≥15 ml/min per 1.73 m2, measured by 51Cr-EDTA renal clearance (mGFR).
Overall, mean DPI estimated from urea excretion was 1.09 ± 0.30 g/kg of body weight per day (range = 0.34-2.76); 20% of patients had values > 1.3 g/kg per day, and 1.9% had values < 0.6 g/kg per day. Urea excretion and food records produced similar estimates of mean DPI. The lower the mGFR, the lower the mean DPI. Over a median follow-up of 5.6 years, there were 319 ESRD events and 189 pre-ESRD deaths. After adjusting for relevant covariates, each 0.1 g/kg daily higher baseline urea excretion-based DPI or food record-based DPI was associated with an HR for ESRD of 1.05 (95% confidence interval 1.01-1.10) or 1.09 (95% confidence interval 1.04-1.14), respectively. HRs were stronger in patients with baseline mGFR < 30 ml/min per 1.73 m2. There was no association with mortality. The mean age of the patients was 59 ± 15 years, and mean body mass index was 26.6 ± 5.2 kg/m2.
In this prospective observational study, the lower the baseline DPI, the slower the progression toward ESRD. Most importantly, the absence of threshold for the relation between DPI and ESRD risk indicates that there is no optimal DPI in the range observed in this cohort.

Keywords
dietary protein intake, end-stage renal disease, glomerular filtration rate, mortality, urinary urea excretion
Pubmed
Web of science
Open Access
Yes
Create date
25/01/2018 21:25
Last modification date
29/05/2019 7:08
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