Chronic kidney disease progression: a retrospective analysis of 3-year adherence to a low protein diet.
The potential benefits and dangers of dietary protein restriction in chronic kidney disease (CKD) are still controversial. Thus, the aim of this study is to evaluate the effect of low protein diet (LPD) on the renal function in nondialysis CKD patients. A retrospective study was conducted from 321 nondialysis CKD patient's medical files (65.1 ± 12.7 yrs, 58.2% men). These patients received individualized dietary protein prescription (0.6-0.8 g protein/kg/day). Protein intake was evaluated by food diary and 24 h-food recall. Adherence to the LPD was considered when patients intake from 90 to 110% of the prescribed amount of protein. The patients were divided into 4 groups: (G1) adherent diabetes mellitus (DM) patients (n = 83); (G2) non-adherent DM patients (n = 106); (G3) adherent non-DM patients (n = 75); (G4) non-adherent non-DM patients (n = 57). Renal function was assessed by estimated glomerular filtration rate (eGFR). Both groups of patients (DM and non-DM) that adhered to the LPD showed significant improvement in eGFR (G1: 38.7 ± 13.2 mL/min to 51.1 ± 17.0 mL/min (p < 0.001); G3: 35.1 ± 16.8 mL/min to 46.8 ± 21.4 mL/min (p < 0.001)). In adherent patients, no differences in albumin and BMI were observed at the end of follow up. In non-adherent patients, eGFR significantly decreased in DM group (G2: 44.2 ± 18.5 mL/min to 38.2 ± 15.8 mL/min (p = 0.003)). According to multivariate analysis, annual changes in eGFR were not independent associated with age, gender, BMI, lipid profile, bicarbonate or smoking status. In summary, adherence to low protein diet could be able to improve serum creatinine and eGFR, well-known markers of renal function. However, prospective studies are needed to control confounders which affect renal function and CKD progression.
a Hospital Federal da Lagoa , Rio de Janeiro , Brazil.
Felipe
F
Rizzetto
b Division of Nutrition , Pedro Ernesto University Hospital, State University of Rio de Janeiro (UERJ) , Rio de Janeiro , Brazil.
Viviane de Oliveira
VO
Leal
c Scientific Computing Program , Oswaldo Cruz Foundation (FIOCRUZ) , Rio de Janeiro , Brazil.
Leonardo Soares
LS
Bastos
d Department of Nephrology , Centre Hopitalier Lyon Sud, INSERM 1060, CENS, Université de Lyon , Pierre-Benite , France.
Denis
D
Fouque
e Graduate Program in Medical Sciences , Federal Fluminense University (UFF) , Niterói , Rio de Janeiro , Brazil.
Denise
D
Mafra
D000368:Aged; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood*; D003920:Diabetes Mellitus / Q000178:diet therapy; D015930:Diet Records; D018753:Diet, Protein-Restricted; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D057285:Precision Medicine / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy*; D012189:Retrospective Studies
D003404:Creatinine
Chronic renal insufficiency; adherence; glomerular filtration rate; protein-restricted diet