Possible Benefits of a Low Protein Diet in Older Patients With CKD at Risk of Malnutrition: A Pilot Randomized Controlled Trial

Abstract

BackgroundCurrent guidelines do not clarify whether older patients with advanced chronic kidney disease (CKD) may benefit of low protein (LP) diet if they are at risk of malnutrition. We compared the effects of normocalorie/normoprotein (NP) and normocalorie/LP diet on nutritional status and metabolic complications related to the progression of kidney damage in these patients.MethodsThis pilot study had an open-label randomized-controlled design (ClinicalTrials.gov Id: NCT05015647). Thirty-five patients were treated for 6 months with two different diets (LP = 17) and (NP = 18). Malnutrition was assessed by the Malnutrition Inflammation Score and International Society of Renal Nutrition and Metabolism criteria. Renal function was assessed by creatinine and cystatin-C-based estimated glomerular filtration rate (eGFR).ResultsAt the end of the study, Malnutrition Inflammation Score was improved in both LP and NP groups (respectively: 3 ± 3 vs. 6 ± 1.5, p = 0.020 and 3 ± 2.5 vs. 6 ± 2, p = 0.012), prevalence of protein energy wasting syndrome decreased only in LP. LP group had higher eGFRcys-C (17 ± 6 vs. 12 ± 4 ml/min/1.73 m2; p < 0.05), lower serum urea (105 ± 65 vs. 138 ± 30 mg/dl; p < 0.05) and lower parathormone (68 ± 10 vs. 99 ± 61 ng/L; p < 0.05) than NP. Serum and urinary phosphorous did not change while fibroblast growth factor 23 (FGF23)-intact and FGF23 c-terminal increased in both groups [FGF23-intact in LP: 70 (48; 98) vs. 126 (90; 410) pg/ml, p < 0.01 and in NP: 86 (57; 194) vs. 143 (119; 186) pg/ml, p < 0.01; FGF23 c-terminal in LP: 77 (30.3; 112) vs. 111 (63; 384) RU/ml, p < 0.01 and in NP: 142 (56.6; 175) vs. 157 (76.7; 281) RU/ml, p < 0.01].ConclusionsLP diet has a favorable impact on nutritional status as much as NP diet with possible greater benefits on the progression of kidney disease and some of its metabolic complications.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT05015647, identifier: NCT05015647.

In Patients with Chronic Kidney Disease Advanced Glycation End-Products Receptors Isoforms (sRAGE and esRAGE) Are Associated with Malnutrition

“…Nearly half of the patients had diabetes (56%), and, on average, they were overweight, with a mean BMI of 28 ± 5 kg/m 2 . Median malnutrition inflammation score was 4 [3][4][5][6][7][8], while eGFR ranged from 60 to 15 mL/min/1.73 m 2 , with a mean value of 25 ± 11 mL/min/1.73 m 2 (stage IV CKD). Nutritional metabolic markers were averagely normal (total cholesterol 168 ± 37 mg/dL; albumin 4.0 ± 0.4 gr/dL; prealbumin 28 ± 5 mg/dL).…”

“…The etiology of malnutrition in chronic kidney disease is complex and multifactorial: reduced food intake because of anorexia, changes in taste, uremic gastritis, and the high number of medicines prescribed may all contribute to reducing energy and protein intake [ 1 , 2 , 3 ]. CKD patients are also characterized by increased oxidative stress and inflammation due to the accumulation of uremic toxins and compromised renal clearance of pro-inflammatory mediators.…”

Indoxyl sulfate mediates low handgrip strength and is predictive of high hospitalization rates in patients with end-stage renal disease

“…The assessment for screening the malnutrition-inflammation-atherosclerosis syndrome (MIA syndrome), the conventional Subjective Global Assessment or protein energy wasting are important for the routine care in CKD patients ( 79 , 80 ). Besides, the measurement for inflammatory indicators such as C-reactive protein might be important for caring the CKD patients ( 81 , 82 ). From our study, the body mass index was similar between groups.…”

MCP1 Could Mediate FGF23 and Omega 6/Omega 3 Correlation Inversion in CKD

“…Plasma FGF23 intact and c-terminal (iFGF23 and cFGF23) were measured by a second-generation two-site enzyme-linked immunosorbent assay ELISA Kit (Immutopics Quidel Co., San Diego, CA, USA) as previous studies [ 28 , 29 ]. The minimal detectable concentration is 1.5 pg/mL and 1.5 RU/mL respectively.…”