scholarly journals Use of Low-Protein Staple Foods in The Dietary Management of Patients With Stage 3-4 Chronic Kidney Disease

2021 ◽  
Author(s):  
Junbao Shi ◽  
Yue Wang ◽  
Song Wang ◽  
Xinhong Lu ◽  
Xinxin Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Crossover Study ◽  
Protein Intake ◽  
Calorie Intake ◽  
Dietary Management ◽  
Low Protein ◽  
Case Crossover ◽  
Staple Foods

Abstract BackgroundMaintaining a low-protein diet (LPD) is important for patients with chronic kidney disease (CKD) to delay renal degradation and alleviate clinical symptoms. For most patients with CKD, it is difficult to maintain the necessary low level of dietary protein intake (DPI). To improve the current dietary management of CKD, we conducted an intervention study by administering low-protein staple foods (LPSF).MethodsWe conducted a prospective case-crossover study among 25 patients with stage 3-4 CKD. During the initial 12 weeks of the study, we instructed the patients regarding a standard LPD according to the recommendations of a renal dietitian. In the second stage of the study, we instructed the patients regarding an LPSF (250 g/d) diet, and followed these patients up for 12 weeks. We compared the DPI, dietary energy intake (DEI), normalized protein equivalent of total nitrogen appearance (nPNA), serum creatinine levels, and nutritional index between baseline and the end of the study.ResultsWe found no change in dietary variables among the patients during the first 12 weeks of the LPD. After subjecting them to an LPSF diet, the corresponding variables showed a pronounced change. The patients’ DPI decreased from 0.88±0.20 to 0.68±0.14 g/kg/d (P<0.01) and the nPNA value decreased from 0.99±0.18 to 0.87±0.19 g/kg/d (P<0.01). The high biological value protein intake proportion increased from 42% (baseline) to 57% (P<0.01) during the 24 weeks. No variation was found in the measured DEI (28.0±5.8 vs 28.6±5.4 kcal/kg/d), nutrition assessment, or renal function and serum creatinine levels.ConclusionOur prospective case-crossover study demonstrated that an LPSF diet can help patients with stage 3-4 CKD reduce DPI and nPNA values, improve the proportion of highly bioavailable proteins, ensure adequate calorie intake, and avoid malnutrition. An LPSF diet is an effective and simple therapy for patients with stage 3-4 CKD.Trial registrationThe research protocol has been registered in the website of Chinese Clinical Trials Register with the reference number ChiCTR 2000030112.

scholarly journals Development and Validation of a Simple Equation to Evaluate Dietary Protein Intake Using the Blood Urea Nitrogen/Serum Creatinine Ratio in Patients With Stage 3 Chronic Kidney Disease

2020 ◽  
Author(s):  
Yanhui Wang ◽  
Zujiao Chen ◽  
Jing Li ◽  
Zhen Li ◽  
Jianteng Xie ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Blood Urea Nitrogen ◽  
Dietary Protein ◽  
Protein Intake ◽  
Simple Equation ◽  
Dietary Protein Intake ◽  
Urea Nitrogen

Abstract Background: A simple, effective and convenient method to assess dietary protein intake (DPI) for chronic kidney disease (CKD) patients is urgently needed in clinical practice. We developed a simple equation to evaluate DPI in patients with stage 3 CKD with the blood urea nitrogen (BUN)/serum creatinine (SCr) ratio (BUN/SCr).Methods: In a prospective cohort of 136 inpatients with stage 3 CKD from 2 centres, we developed estimation equations based on BUN/SCr and the spot urinary urea nitrogen (UUN)/urinary creatinine (UCr) ratio (UUN/UCr) in combination with sex and body mass index (BMI). These equations were then internally and externally validated.Results: The following candidate parameters were derived from univariate regression analysis for 5 established models: sex, BMI, BUN/SCr, UUN and UUN/UCr. Sex and BMI were included in all models after variable evaluation using multiple regression analysis. UUN, UUN/UCr and BUN/SCr were included in model 3, model 4 and model 5, respectively. Both internal validation and external validation indicated that model 5 resulted in the lowest values of bias and root mean square error and the highest P30 compared with model 3 and model 4. Therefore, the model 5 equation, DPI= -5.18 (-14.49 if the patient is female) +1.89×BMI+1.38×BUN/SCr, was selected because of the higher correlation [r = 0.498 (95% confidence interval 0.163,0.719)] and the smaller distribution of the difference between the predicted and measured protein intakes than those of the other models.Conclusion: The DPI equation developed using BUN/SCr, sex and BMI may be used to estimate protein intake for patients with stage 3 CKD.Trial registrationChinese Clinical Trial Registry Center (ChiCTR-ROC-17011363). Registered in 11 May 2017, Retrospectively registered, http://www.chictr.org.cn/index.aspx

scholarly journals Age Modifies the Association of Dietary Protein Intake with All-Cause Mortality in Patients with Chronic Kidney Disease

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1744 ◽  
Author(s):  
Daiki Watanabe ◽  
Shinji Machida ◽  
Naoki Matsumoto ◽  
Yugo Shibagaki ◽  
Tsutomu Sakurada
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dietary Protein ◽  
Protein Intake ◽  
Ideal Body Weight ◽  
The Elderly ◽  
Dietary Protein Intake ◽  
Low Protein ◽  
All Cause Mortality ◽  
Stage Renal Disease

Whether the effect of a low-protein diet on progression to end-stage renal disease (ESRD) and mortality risk differs between young and elderly adults with chronic kidney disease (CKD) is unclear. We conducted a retrospective CKD cohort study to investigate the association between protein intake and mortality or renal outcomes and whether age affects this association. The cohort comprised 352 patients with stage G3-5 CKD who had been followed up for a median 4.2 years, had undergone educational hospitalization, and for whom baseline protein intake was estimated from 24-h urine samples. We classified the patients into a very low protein intake (VLPI) group (<0.6 g/kg ideal body weight/day), a low protein intake (LPI) group (0.6–0.8 g), and a moderate protein intake (MPI) group (>0.8 g). Compared with the LPI group, the MPI group had a significantly lower risk of all-cause mortality (hazard ratio: 0.29; 95% confidence interval: 0.07 to 0.94) but a similar risk of ESRD, although relatively high protein intake was related to a faster decline in the estimated glomerular filtration rate. When examined per age group, these results were observed only among the elderly patients, suggesting that the association between baseline dietary protein intake and all-cause mortality in patients with CKD is age-dependent.

scholarly journals Dietary satisfaction and quality of life in chronic kidney disease patients on low-protein diets: a multicentre study with long-term outcome data (TOrino-Pisa study)

2019 ◽  
Vol 35 (5) ◽  
pp. 790-802 ◽  
Author(s):  
Giorgina Barbara Piccoli ◽  
Biagio Raffaele Di Iorio ◽  
Antoine Chatrenet ◽  
Claudia D’Alessandro ◽  
Marta Nazha ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Multicentre Study ◽  
Protein Intake ◽  
Low Protein ◽  
Protein Diets

Abstract Background Concerns about adherence and quality of life (QoL) limit the diffusion of low-protein diets (LPDs) as a way to slow chronic kidney disease (CKD) progression and postpone dialysis. The aim of this multicentre study is to assess dietary satisfaction in stable CKD patients. Methods This was a multicentre cross-sectional study with long-term follow-up data. Prevalent patients on LPD for at least 6 months were selected in four Italian centres. QoL was assessed using the World Health Organization Quality of Life questionnaire, and diet satisfaction with the Modification of Diet in Renal Disease satisfaction questionnaire. Comorbidity was assessed by Charlson Comorbidity Index, estimated glomerular filtration rate (eGFR) was calculated by the CKD Epidemiology Collaboration equation and protein intake by Maroni–Mitch formula. Survival was analysed with Kaplan–Meier curves and Cox Proportional Hazard Model. Results Four hundred and twenty-two CKD Stages 3–5 patients were enrolled. Over 95% were on moderately restricted diets (0.6 g/kg/day). Compliance was good (protein intake: 0.59 g/kg/day at baseline, 0.72 at the end of follow-up). Median dietary satisfaction was 4 on a 1–5 scale. QoL was not affected by the type of diet, but was influenced by age, comorbidity and setting of care. Two years later, at the end of follow-up, 66.6% of the patients were still on a diet; the main causes of discontinuation were dialysis and death. The dropout rate was low (5.5%); in Cox analysis, patient and renal survival were influenced by age and eGFR, but not by QoL, setting of care or type of diet. Conclusions LPDs are compatible with high dietary satisfaction and minimal dropout, at least in patients who are able to follow such a diet for at least 6 months.

Economic Effects of Treatment of Chronic Kidney Disease with Low-Protein Diet

2013 ◽  
Author(s):  
Francesco Saverio Mennini ◽  
Simone Russo ◽  
Andrea Marcellusi ◽  
Giuseppe Quintaliani ◽  
Denis Fouque
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Economic Effects ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein

scholarly journals Delayed Exercise Training Improves Obesity-Induced Chronic Kidney Disease by Activating AMPK Pathway in High-Fat Diet-Fed Mice

2020 ◽  
Vol 22 (1) ◽  
pp. 350
Author(s):  
Florian Juszczak ◽  
Maud Vlassembrouck ◽  
Olivia Botton ◽  
Thomas Zwakhals ◽  
Morgane Decarnoncle ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Training ◽  
High Fat Diet ◽  
Interstitial Fibrosis ◽  
Calorie Intake ◽  
Acid Oxidation ◽  
Obese Mice ◽  
High Fat ◽  
Ampk Pathway

Exercise training is now recognized as an interesting therapeutic strategy in managing obesity and its related disorders. However, there is still a lack of knowledge about its impact on obesity-induced chronic kidney disease (CKD). Here, we investigated the effects of a delayed protocol of endurance exercise training (EET) as well as the underlying mechanism in obese mice presenting CKD. Mice fed a high-fat diet (HFD) or a low-fat diet (LFD) for 12 weeks were subsequently submitted to an 8-weeks EET protocol. Delayed treatment with EET in obese mice prevented body weight gain associated with a reduced calorie intake. EET intervention counteracted obesity-related disorders including glucose intolerance, insulin resistance, dyslipidaemia and hepatic steatosis. Moreover, our data demonstrated for the first time the beneficial effects of EET on obesity-induced CKD as evidenced by an improvement of obesity-related glomerulopathy, tubulo-interstitial fibrosis, inflammation and oxidative stress. EET also prevented renal lipid depositions in the proximal tubule. These results were associated with an improvement of the AMPK pathway by EET in renal tissue. AMPK-mediated phosphorylation of ACC and ULK-1 were particularly enhanced leading to increased fatty acid oxidation and autophagy improvement with EET in obese mice.

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