title: Association between Low Dietary Protein Intake and Geriatric Nutrition Risk Index in Patients with Chronic Kidney Disease: A Retrospective Single-Center Cohort Study.
abstract: Reduced dietary protein intake in malnourished patients with chronic kidney disease (CKD) may be associated with adverse clinical outcomes, which may mask any efficacy of a low-protein diet. The study included 126 patients with CKD who attended a dedicated dietary counseling clinic in 2005-2009 and were systematically followed until January 2015. Of these patients, 20 (15.9%) had moderate or severe nutrition-related risk of geriatric nutritional risk index (GNRI) < 92; these patients were more likely to be older, have a greater proteinuria, and have lower body mass index and serum albumin concentration. Dietary protein intake was significantly lower in older patients (r= -0.33,p< 0.001) and those with lower glomerular filtration rate (r= 0.47,p< 0.001). The non-protein to nitrogen calorie ratio was independently associated with GNRI. Reduced GNRI was significantly associated with mortality (hazard ratio (HR) = 4.94; 95% confidence interval (CI) = 1.61-15.42,p= 0.012) and cardiovascular events (HR = 9.37; 95% CI = 2.49-37.34,p= 0.006), but not with adverse renal outcomes. Restricting protein intake may be harmful to patients with any nutrition-related risk, suggesting that improvement of nutritional status should be a high priority.
authors: Department of Nephrology, Omori Medical Center, School of Medicine, Toho University, Tokyo 143-8541, Japan. aki.futaki@med.toho-u.ac.jp.
authors: Aki
authors: A
authors: Kiuchi
authors: Department of Nephrology, Sakura Medical Center, School of Medicine, Toho University, 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan. ohashiy@med.toho-u.ac.jp.
authors: Yasushi
authors: Y
authors: Ohashi
authors: Department of Nephrology, Omori Medical Center, School of Medicine, Toho University, Tokyo 143-8541, Japan. reibin_1027@med.toho-u.ac.jp.
authors: Reibin
authors: R
authors: Tai
authors: Department of Nephrology, Omori Medical Center, School of Medicine, Toho University, Tokyo 143-8541, Japan. toshi.a.77@med.toho-u.ac.jp.
authors: Toshiyuki
authors: T
authors: Aoki
authors: Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima 731-5134, Japan. sm210@med.toho-u.ac.jp.
authors: Sonoo
authors: S
authors: Mizuiri
authors: Department of Nutrition, Omori Medical Center, Toho University, Tokyo 143-8541, Japan. ogura-tyk-000@med.toho-u.ac.jp.
authors: Toyoko
authors: T
authors: Ogura
authors: Department of Nephrology, Omori Medical Center, School of Medicine, Toho University, Tokyo 143-8541, Japan. aaikawa@med.toho-u.ac.jp.
authors: Atsushi
authors: A
authors: Aikawa
authors: Department of Nephrology, Omori Medical Center, School of Medicine, Toho University, Tokyo 143-8541, Japan. kensakai@med.toho-u.ac.jp.
authors: Ken
authors: K
authors: Sakai
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D018753:Diet, Protein-Restricted / Q000009:adverse effects*; D004044:Dietary Proteins; D004435:Eating; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000209:etiology / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis
chemical_list: D004044:Dietary Proteins; D012709:Serum Albumin
keywords: body composition; body mass index; chronic kidney disease; food intake; geriatric nutritional risk index; nutritional status; serum albumin; wasting syndrome