An investigation of low-protein diets' qualification rates and an analysis of their short-term effects for patients with CKD stages 3-5: a single-center retrospective cohort study from China.

Abstract

BACKGROUND:

The feasibility and efficacy of low-protein diets (LPD) treatment in chronic kidney disease (CKD) is controversial. Based on the characteristics of the Chinese diet, we observe the qualification rates and short-term clinical effects of LPD for CKD patients in our center.

METHODS:

This is a retrospective cohort study. CKD stages 3-5 patients who were regularly followed up 5 times (over 2 years) and treated with LPD were included. We collected clinical data to observe the changes in LPD qualification rates and divided patients into LPD and non-LPD group according to the average dietary protein intake (DPI) of 5 follow-up time points and compared the changes in primary and secondary outcome measures between the two groups.

RESULTS:

We analyzed data from 161 eligible CKD stages 3-5 patients. From baseline to the 5th follow-up time point, the LPD qualification rates of all patients were 11.80%, 35.40%, 47.82%, 53.43% and 54.04%, respectively. For primary outcome measures, the urine protein/creatinine ratio (UPCR) decreased more in the LPD group than in the non-LPD group [Median (interquartile range, IQR) of the difference between the 5th follow-up time point and baseline: 0.19 (- 0.01-0.73) vs. 0.10 (- 0.08-0.27), P < 0.001]. We constructed three classes of mixed linear models (model I, II, III). The UPCR slopes were all negative in the LPD group and positive in the non-LPD group (P < 0.001). Meanwhile, in model I, the estimate glomerular filtration rate(eGFR) decline slope in the LPD group was lower than that in the non-LPD group [slope (standard error): - 1.32 (0.37) vs. - 2.35 (0.33), P = 0.036]. For secondary outcome measures, body mass index (BMI) triglycerides (TG), body weight, and fat free mass (FFM) showed stable statistical differences in the comparison of LPD and non-LPD groups, with greater declines in the former.

CONCLUSION:

The results of this study suggest that LPD treatment can reduce UPCR in patients with CKD stages 3-5, and may also delay the decline in eGFR. Meanwhile, it also reduces BMI, TG, body weight, and FFM, thus the need to prevent malnutrition in clinical implementation.

• Authors: Xian-Long Zhang, Min Zhang, Nuo Lei, Wen-Wei Ouyang, Hui-Fen Chen, Bei-Ni Lao, Yan-Min Xu, Fang Tang, Li-Zhe Fu, Xu-Sheng Liu, Yi-Fan Wu
• Journal: International urology and nephrology (Int Urol Nephrol) Vol. 55 Issue 4 Pg. 1059-1070 (Apr 2023) ISSN: 1573-2584 [Electronic] Netherlands
• PMID: 36310191 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Chemical References

• Dietary Proteins
• Triglycerides

Topics

• Humans
• Diet, Protein-Restricted
• Dietary Proteins
• Retrospective Studies
• China
• Body Weight
• Glomerular Filtration Rate
• Renal Insufficiency, Chronic (complications)
• Triglycerides
• Disease Progression