Kidney Week

Abstract: SA-PO801

Adherence to a Low-Protein Diet (LPD) Is Associated with Slower Rate of eGFR Decline in Patients with CKD

Session Information

• Health Maintenance, Nutrition, Metabolism - II
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1300 Health Maintenance, Nutrition, and Metabolism

Authors

• Angeletti, Andrea, Sant'Orsola-Malpighi Hospital, Bologna, Italy

Andrea Angeletti,

• Zappulo, Fulvia, Sant'Orsola-Malpighi Hospital, Bologna, Italy

Fulvia Zappulo,

• Fribourg, Miguel, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Miguel Fribourg,

• Farouk, Samira S., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Samira S. Farouk,

• Guglielmo, Chiara, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Chiara Guglielmo,

• Andrighetto, Sofia, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Sofia Andrighetto,

• Hartzell, Susan, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Susan Hartzell,

• Cantarelli, Chiara, Università di Parma, Parma, Italy

Chiara Cantarelli,

• Manrique, Joaquin, Complejo Hospital de Navarra, Pamplona, Spain

Joaquin Manrique,

• La Manna, Gaetano, Sant'Orsola-Malpighi Hospital, Bologna, Italy

Gaetano La Manna,

• Cravedi, Paolo, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Paolo Cravedi,

Background

LPD is considered an effective strategy to defer transition to dialysis in patients with CKD through azotemia reduction. However, whether dietary protein intake impacts the rate of kidney function decline remains controversial.

Methods

We included 135 patients with an eGFR between 20 and 60 mL/min/1.73m² who started LPD (0.6-0.7g/kg/d) between 2015 and 2017 and retrospectively collected clinical history (diabetes status and RAASi therapy), serial eGFR (CKD-EPI), proteinuria, and urinary phosphorus. Dietary energy intake was >30Kcal/Kg/d. eGFR and 24h proteinuria were collected at the time of LPD initiation and at 6 and 12mo before and after LPD initiation.These time points were used to generate eGFR slopesbefore and after starting LPD. Adherence to LPD was estimated based on phosphaturia at 6mo after starting LPD. Patients on immunosuppressive therapy were excluded.

Results

There was a significant decrease in the rate of eGFR decline after LPD initiation (eGFR slopes: -0.35 ± 0.007 vs. -0.02 ± 0.003 ml/min/1.73m²/month before vs. after LPD; p = 0.0007) (Fig. 1), though proteinuria did not significantly change. Univariate analyses showed that phosphaturia was the only variable significantly (p = 0.05) associated with rate of eGFR change, while diabetes status, RAASi therapy, and proteinuria at baseline were not. In a multivariate analyses, phosphaturia retained an independent association.

Conclusion

This retrospective, single center study shows that adherence to LPD is independently associated with ameliorated kidney function decline. These data support strategies to increase patient adherence to LPD. Further studies are needed to elucidate mechanisms by which LPD exerts renoprotection.

Fig. 1. Average eGFR at different time points before and after low-protein diet initiation. Grey dots represent single patients.