Higher protein intake is associated with increased risk for incident end-stage renal disease among blacks with diabetes in the Southern Community Cohort Study

Abstract

Background and Aims Diabetes, a risk factor for end-stage renal disease (ESRD), is associated with impaired protein metabolism. We investigated whether protein intake is associated with ESRD and whether the risk is higher among blacks with diabetes. Methods and Results We conducted a nested case-control study of ESRD within the Southern Community Cohort Study, a prospective study of low-income blacks and whites in the southeastern US (2002-2009). Through 2012, 1,057 incident ESRD cases were identified by linkage with the United States Renal Data System and matched to 3,198 controls by age, sex, and race. Dietary intakes were assessed from a validated food frequency questionnaire at baseline. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed from logistic regression models that included matching variables, BMI, education, income, hypertension, total energy intake, and percent energy from saturated and polyunsaturated fatty acids. Mean (±SD) daily energy intake from protein was higher among ESRD cases than controls (15.7±3.3 vs. 15.1±3.1%, P<0.0001). For a 1% increase in percent energy intake from protein, the adjusted ORs (95% CIs) for ESRD were 1.06 (1.02-1.10) for blacks with diabetes, 1.02 (0.98-1.06) for blacks without diabetes, 0.99 (0.90-1.09) for whites with diabetes and 0.94 (0.84-1.06) for whites without diabetes. Protein intake in g/kg/day was also associated with ESRD (4th vs. 1st quartile OR=1.76; 95% CI: 1.17-2.65). Conclusion Our results raise the possibility that among blacks with diabetes, increased dietary protein is associated with increased incidence of ESRD. Studies on how protein intake and metabolism affect ESRD are needed.

High Protein Diet that Cause Weight Loss and Lower Blood Glucose Level Have a Serious Impact on the Kidney Functions of Male Diabetic Obese Albino Rats

“…Our finding can be explaned by hyperfiltration that caused by HP leading to subsequent renal damage, as postulated by Brenner et al, [47] [54]. It may also be possible that by-products of excess protein metabolism could cause injury to podocytes and other kidney cells resulting in impaired kidney function and subsequent ESRD [53].…”

Association of unhealthy dietary behaviors with renal function decline in patients with diabetes

“…High dietary protein intake is thought to increase the nitrogen load, glomerular filtration rate, and renal hypertrophy 33. Malhotra et al also proved that increased dietary protein was associated with the incidence of end-stage kidney disease in patients with diabetes 34. This study also demonstrated that patients with diabetes with excessive dietary protein may increase the 8.9% incidence of eGFR decline, ≥40%, but this finding was not statistically significant (OR 1.089, 95% CI 0.716 to 1.656, p=0.690).…”

Racial disparities in end-stage renal disease in a high-risk population: the Southern Community Cohort Study

“…Approximately 86% of participants were enrolled at participating community health centers (CHC), institutions which provide primary health and preventive services in medically underserved areas [10]. A detailed description of SCCS methods is available on the study website (http://www.southerncommunitystudy.org/) and in previous publications [9, 11–13]. SCCS participants provided written informed consent, and protocols were approved by the Institutional Review Boards of Vanderbilt University Medical Center and Meharry Medical College.…”