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Abstract: PO0461

Changes in Dietary Protein Intake and Outcomes Among Patients with CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Obi, Yoshitsugu, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Mohamed, Mahmoud Magdy, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Hassan, Waleed, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Abu Farsak, Hisham Neyazi, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Patel, Abhishek J., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Akhtar, Jawed, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Mahmoud, Mahmoud A., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Sumida, Keiichi, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Molnar, Miklos Zsolt, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Wall, Barry M., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
Background

Protein energy wasting is common and associated with poor outcomes in CKD while low protein diet is recommended to delay the development of ESRD. However, the clinical relevance of the temporal change in dietary protein intake (DPI) in real-world data remains unclear in this population.

Methods

We performed repeated collections of morning spot urine in a prospective cohort of non-dialysis dependent veterans with CKD at a single institution. We assessed urine urea nitrogen-to-creatinine ratio to estimate 24-hour urine urea excretion and then estimated DPI using the Maroni formula. Among 345 patients who had data on DPI between 6-12 months from the initial measurement, we estimated the slope of DPI in mixed effects models and examined its association with subsequent ESRD and all-cause mortality in cause-specific hazard models with adjustment for demographics, Charlson Comorbidity Index, eGFR, urinary protein, smoking status, body mass index, and baseline DPI.

Results

Patients were 68±10 years old, 97% were male, 36% were African American, and their baseline eGFR was 34±12 ml/min/1.73m2. Baseline DPI was median 0.55 (IQR, 0.45–0.67) g/kg/day and its slope was 0.01±0.04 g/kg/day per year. During a median follow-up of 4.2 years, 129 died (104/1000 PY) and 87 developed ESRD (83/1000 PY). Decrease in DPI was associated with lower risk of ESRD (HR 0.94 [95%CI, 0.89-0.99] per 0.01 g/kg/day per year; P=0.025), but not with mortality risk (P=0.84). Non-linear regression models confirmed these findings (Figure). Compared to patients who had no change in DPI, the hazard ratio (95%CI) of death and ESRD in those with a change of -0.03 g/kg/day per year were 1.12 (0.95-1.47) and 0.71 (0.52-0.98), respectively.

Conclusion

In patients with CKD, DPI showed a relatively small intraindividual temporal variation, but decrease in DPI was significantly associated with lower risk of ESRD, without an association with mortality.