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Protein intake in renal disease

C A Pollock1, L S Ibels, F Y Zhu

  • 1Department of Renal Medicine, Royal North Shore Hospital, New South Wales, Australia.

Journal of the American Society of Nephrology : JASN
|May 1, 1997
PubMed
Summary

Dietary protein intake (DPI) in patients with renal impairment is often lower than recommended, regardless of dietary advice. Patients adapt to higher protein intake after starting dialysis, but this takes 6-9 months.

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Area of Science:

  • Nephrology
  • Nutritional Science
  • Clinical Medicine

Background:

  • Dietary protein intake (DPI) is a critical factor in managing renal impairment.
  • Understanding patient adherence to dietary recommendations is essential for effective treatment.
  • The transition to dialysis requires nutritional adjustments, particularly protein intake.

Purpose of the Study:

  • To assess dietary protein intake (DPI) in patients with varying degrees of renal function.
  • To evaluate the correlation between DPI and renal dysfunction, patient demographics, and clinical markers.
  • To examine the short-term and long-term adaptation of DPI following the initiation of dialysis.

Main Methods:

  • Dietary protein intake (DPI) was determined using 24-hour urinary urea and protein excretion via urea kinetic modeling in 766 patients.

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  • Patients were categorized based on serum creatinine levels (normal vs. increased) and dietary advice (low-protein diet vs. no restriction).
  • A subset of patients (n=99) were assessed before and at different intervals after commencing dialysis.

    • Main Results:

    • Patients with normal serum creatinine and no dietary restriction had significantly higher DPI (1.08 g/kg/day) compared to those advised to restrict protein (0.96 g/kg/day).
    • Lower DPI correlated with the severity of renal dysfunction, independent of dietary advice.
    • DPI correlated with BMI, serum albumin, age, blood glucose, serum cholesterol, and triglyceride levels.
    • Following dialysis initiation, DPI did not increase significantly within the first 3 months (0.79 vs. 0.82 g/kg/day).
    • However, DPI significantly increased 6-9 months after dialysis initiation (1.04 g/kg/day).

    Conclusions:

    • Low dietary protein intake in renal impairment can occur independently of formal dietary advice.
    • Patients demonstrate compliance with low-protein diet recommendations when advised.
    • Adaptation to increased protein intake post-dialysis is delayed, occurring significantly only after 6-9 months.