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.

Association of Geriatric Nutritional Risk Index with Mortality in Hemodialysis Patients: A Meta-Analysis of Cohort Studies

“…Lee et al revealed that a worsening or stationary GNRI was independently associated with higher risk for major adverse cardiac and cerebrovascular events (MACCEs) in PD patients by multivariate cox analysis [48]. And reduced GNRI was also significantly associated with mortality and cardiovascular events in CKD patients not on dialysis treatment [40]. Our results have strengthened the above conclusion.…”

“…Moreover, they also found that lowmiddle GNRI have the highest mortality rate (HR 4.28, 95%CI 2.66 to 6.88) if patients with low phosphorus level [38]. The association between GNRI and mortality has been further validated from PD and nondialysis CKD patients [39,40]. Based on all the available studies, our meta-analysis further confirmed the results that high GNRI score can decrease the risk of all-cause mortality, while low GNRI was associated with high mortality for dialysis patients.…”

Low-protein diet supplemented with ketoacids delays the progression of diabetic nephropathy by inhibiting oxidative stress in the KKAy mice model

“…The renoprotective effects of LPD have been demonstrated in animal models of DN (7,14) ; further, positive results with use of LPD have been reported from several clinical trials on patients with DN (44,45) . However, the results from human studies have not been consistent in different experimental settings (6,9,46) . Protein overload activates the RAS, and LPD + KA has been shown to inhibit the intrarenal RAS (47) .…”

Decreased Bioimpedance Phase Angle in Patients with Diabetic Chronic Kidney Disease Stage 5

“…In general, reduced protein intake, limited sodium and potassium intake, and reduced phosphorus intake in patients with CKD are emphasized. However, there is still controversy as to the relative advantages and disadvantages of limiting protein intake to prevent the progression of CKD without causing protein energy wasting [12]. Nutritional therapy, which can prevent the deterioration of kidney function in patients with DMCKD, and even better control of blood sugar, blood pressure, and lipid profile, are also very important [13].…”