Optimum dietary protein requirement in nondiabetic maintenance hemodialysis patients.
BACKGROUND
There is controversy about whether the dietary protein requirement of 1.2 g/kg/d for hemodialysis (HD) patients, in the nutritional guidelines recommended by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI), is reasonable.


METHODS
A cross-sectional study was conducted in 129 stable HD patients without diabetes (84 men, 45 women) to investigate the association between the protein equivalent of nitrogen appearance normalized by ideal body weight (nPNAibw), an index of protein intake, and skeletal muscle mass or other metabolic consequences. Patients were divided into 5 groups according to nPNAibw index. Midthigh muscle area (TMA), midthigh subcutaneous fat area (TSFA), abdominal muscle area (AMA), abdominal subcutaneous fat area (ASFA), and visceral fat area (AVFA) were measured using computed tomography, and various nutritional parameters were compared among these groups.


RESULTS
TMA and AMA values increased with increasing dietary protein intake from less than 0.7 g/kg/d to 0.9-1.1 g/kg/d and showed a plateau at greater than 0.9 to 1.1 g/kg/d of dietary protein intake. Conversely, fat mass, including TSFA, ASFA, and AVFA, and serum potassium concentration increased with graded protein intake, and no plateau was formed. Patients with nPNAibw greater than 1.3 g/kg/d satisfied the criterion of visceral obesity. Although serum prealbumin levels showed a trend similar to that of muscle mass, there was no significant difference in serum albumin levels among the study groups.


CONCLUSIONS
Optimal dietary protein requirement for patients undergoing maintenance HD in a stable condition appears to be less than the level recommended by the NKF-KDOQI nutritional guidelines.
Department of Clinical Nutrition, School of Food and Nutritional Sciences, University of Shizuoka, Miyaji Hospital, Shizuoka, Japan.
Sakae
S
Ohkawa
Yukiko
Y
Kaizu
Mari
M
Odamaki
Naoki
N
Ikegaya
Ikuo
I
Hibi
Kunihiko
K
Miyaji
Hiromichi
H
Kumagai
D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D003430:Cross-Sectional Studies; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000378:metabolism; D009584:Nitrogen; D009751:Nutritional Requirements; D006435:Renal Dialysis / Q000592:standards; D014057:Tomography, X-Ray Computed
D004044:Dietary Proteins; D009584:Nitrogen