Malnourished Kidney Disease Patients Should Avoid Low Protein Diet

24 Oct 2016 --- Malnourished chronic kidney disease patients (CKD) with a reduced dietary protein intake may be subjected to adverse clinical outcomes, potentially masking any efficacy of a low-protein diet, according to a new study published in the Journal Nutrients.

Current clinical practice guidelines for adult patients with chronic kidney disease (CKD) recommend that protein is restricted in the diet, with a guideline dietary intake of 0.6–0.8 g/kg body weight per day.

Further guidelines stated that dietary energy intake must cover energy requirements up to 35 kcal/kg/day for patients younger than 65 and 30 kcal/kg/day for patients older that 65. Intake of qualitative aspects of foods, such as essential amino acid, ketoacids, calcium carbonate, vitamins, and iron are also important, and phosphate and sodium should also be reduced.

However, the researchers say that protein restriction is only a part, though a very relevant part, of a more complex dietary management of CKD patients, and that their findings indicate the importance of maintaining adequate nutrition and energy intake in patients on restricted dietary protein, by increasing caloric intake from carbohydrates and/or fats.

The study looked at 126 patients with chronic kidney disease who attended a dedicated dietary counseling clinic in 2005–2009 and were then systematically followed until January 2015.

The researchers used the geriatric nutritional risk index (GNRI), which consists of BMI and serum albumin concentration, and is a simple tool that assesses nutrition-related risk and may indicate reduced body stores of protein and energy.

Of the 126 patients, 16% had moderate or severe nutrition-related risk of geriatric nutritional risk index (GNRI). These patients were more likely to be older, have a greater proteinuria, and have lower body mass index and serum albumin concentration.

The study also found that the dietary protein intake was significantly lower in older patients along with those with lower glomerular filtration rate.

The researchers concluded that restricting protein intake may be harmful to patients with any nutrition-related risk, suggesting that improvement of nutritional status should be a high priority for CKD patients.