Relationship between nutritional status and the glomerular filtration rate: Results from the MDRD Study

Kopple, Joel D.; Greene, Tom; Chumlea, W. Cameroon; Hollinger, Donna; Maroni, Bradley J.; Merrill, Donna; Scherch, Laura Kinzel; Schulman, Gerald; Wang, Shin Ru; Zimmer, Gail S.

doi:10.1046/j.1523-1755.2000.00014.x

Cited by 379 publications

(251 citation statements)

References 41 publications

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“…In a prospective study with minimal dietary interventions, Ikizler et al (1995) demonstrated that the decline in renal function was accompanied by a decrease in protein intake. In the baseline period of the Modification of Diet in Renal Disease (MDRD) study, a cross-sectional analysis showed a direct correlation between glomerular filtration rate and nutritional status that is, patients with low glomerular filtration rate had lower protein and energy intake, and decreased anthropometric parameters (Kopple et al, 2000). Some findings were similarly observed in the MDRD study and in the present one; however, there were differences comparing the populations studied.…”

Section: Discussionsupporting

confidence: 69%

“…This finding suggests that factors related to the loss of renal function other than anorexia are important to the deterioration of the nutritional condition. These results differ somewhat from those found in the MDRD study, where the relation between nutritional parameters and glomerular filtration rate were markedly reduced after controlling for protein and energy intake (Kopple et al, 2000). Malnutrition at the initiation of dialysis has been implicated in poor outcome and higher morbidity and mortality risk (Hakim & Lazarus, 1995;Holland & Lam, 2000).…”

Section: Discussionmentioning

confidence: 68%

“…In the first quartile of renal function (CrClo19.9 ml/min), food consumption and anthropometric parameters were significantly lower than those observed in the fourth one (CrClZ43 ml/ min). Two other observational studies have addressed this issue (Ikizler et al, 1995;Kopple et al, 2000). In a prospective study with minimal dietary interventions, Ikizler et al (1995) demonstrated that the decline in renal function was accompanied by a decrease in protein intake.…”

Section: Discussionmentioning

confidence: 99%

“…The degree of renal function at which anorexia initiates is not well established. Few studies have reported the relation between loss of renal function and the decline in dietary intake with subsequent reduction in nutritional indices (Ikizler et al, 1995;Kopple et al, 2000). As in the nondialysis stage of chronic renal disease low-protein diets are frequently prescribed, it is difficult to identify whether the decreased nutrient intake is because of the dietary restrictions or because of anorexia.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2003

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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.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2003

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“…In nontransplant native renal disease, this classification scheme is appropriate as the prevalence of complications increases significantly as the GFR declines (1). Hypertension (2), anemia (3) and hypoalbuminemia (4), to name a few, are all more prevalent at lower levels of GFR.…”

Section: Introductionmentioning

confidence: 99%

The Burden of Chronic Kidney Disease in Renal Transplant Recipients

Karthikeyan

Karpinski

Nair

et al. 2004

American Journal of Transplantation

139

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The National Kidney Foundation has developed guidelines for the diagnosis and classification of chronic kidney disease (CKD) but it is not known whether these are applicable to renal transplant recipients. This study determined the prevalence of CKD according to the stages defined in the guidelines, the complications related to CKD and whether the prevalence of complications was related to CKD stage in 459 renal transplant recipients. CKD was present in 412 patients (90%) and

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Association Between Glycemic Control and Adverse Outcomes in People With Diabetes Mellitus and Chronic Kidney Disease

Shurraw

Hemmelgarn²,

Lin³

et al. 2011

Arch Intern Med

245

163

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A hemoglobin A(1c) level higher than 9% is common in people with non-hemodialysis-dependent CKD and is associated with markedly worse clinical outcomes; lower levels of HbA(1c) (<6.5%) also seemed to be associated with excess mortality. The excess risk of kidney failure associated with a higher HbA(1c) level was most pronounced among people with better kidney function. These findings suggest that appropriate and timely control of HbA(1c) level in people with DM and CKD may be more important than previously realized, but suggest also that intensive glycemic control (HbA(1c) level <6.5%) may be associated with increased mortality.

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Relationship between nutritional status and the glomerular filtration rate: Results from the MDRD Study

Cited by 379 publications

References 41 publications

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

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

The Burden of Chronic Kidney Disease in Renal Transplant Recipients

Association Between Glycemic Control and Adverse Outcomes in People With Diabetes Mellitus and Chronic Kidney Disease

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