Influence of renal function on spontaneous dietary intake and on nutritional status of chronic renal insufficiency patients

Abstract

Objective: To analyze the spontaneous food intake and the nutritional parameters of patients with different degrees of chronic renal insufficiency (CRI) at the onset of predialysis treatment. Design: Cross-sectional. Setting: Outpatient Clinic of the Nephrology Division of Federal University of São Paulo, Brazil. Subjects: The analysis involved 487 (187 women and 300 men) patients with moderate to advanced CRI who were evaluated in the first visit to the clinic. Results: Patients were divided according to creatinine clearance (CrCl) quartiles. CrCl in the first quartile was lower than 19.9 ml/min/1.73 m 2 and in the fourth one was higher than 43 ml/min/1.73 m 2 . Energy intake was significantly (Po0.05) lower in the first quartile when compared with the fourth one while protein intake estimated by protein equivalent of nitrogen appearance (PNA) was significantly lower in the first, second and third quartiles in comparison with the fourth (Po0.05). Body mass index (BMI) and percentage of ideal body weight were significantly decreased in the three lowest levels of renal function. Standard per cent of triceps skinfold thickness was lower in the first quartile when compared with the fourth one. Compared with the fourth quartile, standard per cent of midarm muscle circumference (MAMC) was lower in the second and in the third quartile. CrCl correlated directly and significantly with PNA (r ¼ 0.30; Po0.01), energy intake (r ¼ 0.17; Po0.01), and MAMC (r ¼ 0.20; Po0.01). In a multiple linear regression analysis, controlling for energy and protein intake, CrCl correlated significantly and positively with BMI and MAMC. Conclusion: This study suggests that a spontaneous decrease in energy and protein intake as well as in anthropometric indices follows a decline in renal function in patients with no previous dietary intervention. Sponsorship: This study was supported by CAPES and Oswaldo Ramos Foundation.

Etiology of the Protein-Energy Wasting Syndrome in Chronic Kidney Disease: A Consensus Statement From the International Society of Renal Nutrition and Metabolism (ISRNM)

“…22,23 Although few studies exist in CKD stages 1-3, a progressive, spontaneous decrease in food intake occurs with greater loss of kidney function, which correlates with accumulation of nitrogen-derived uremic toxins. [24][25][26] The factors influencing food intake involve not only metabolic signals but also anomalies in the digestive system and psychological and acquired aspects, including a desire for pleasure, social behavior, and customs. 27 Anorexia may be mediated by circulating appetite regulators, such as gastric mediators (such as cholecystokinin, 28 peptide YY, 29 ghrelin, 30,31 or obestatin), adipokines (such as leptin 32 and visfatin 33 ), or cytokines (such as tumor necrosis factor [TNF], interleukin [IL]-6, and IL-1b 19,20 ), but these mediators need additional research in the uremic milieu.…”

The effect of frequent hemodialysis on nutrition and body composition: Frequent Hemodialysis Network Trial

“…Chronic kidney disease is often accompanied by reductions in serum albumin and prealbumin and progressive loss of muscle and adipose tissue, likely due to inadequate macronutrient intake, inflammation (1), metabolic acidosis (2,3), reduced physical activity (4), or a combination of these processes (5,6,7). Protein-energy wasting (PEW) generally tends to progress slowly once dialysis is initiated (8,9).…”

Sodium Intake, ACE Inhibition, and Progression to ESRD

“…Urinary sodium and urea excretion at the last visit were not considered to avoid an undesirable adjustment for sequelae, 35 related to an anorectic decrease in nutritional intake just before the start of dialysis in patients progressing to ESRD. 42 All analyses were also performed using nonnormalized sodium excretion as an independent variable and the two sodium metrics were compared through Bayesian information criteria. 43 All statistical analyses were performed using R software (version 2.5.1).…”