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Abstract: PO0457

Dietary Phosphorus Restriction Improves Renal Function, Blood Pressure, FGF-23, and Klotho Levels in CKD Stages 1 and 2

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Saxena, Anita, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Sachan, Trisha, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Gupta, Amit, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Kumar, Anup, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Sharma, Sachin, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Background



To evaluate Impact of dietary education and intervention (phosphorus restriction) on creatinine, eGFR, FGF23, Klotho and blood pressure.

Methods

105 subjects (CKD stages 1, 2 N 70; 35controls) evaluated for eGFR, creatinine , phosphorus, calcium, FGF-23, soluble α-Klotho iPTH FGF 23, blood pressure and 3 days dietary intake, using standard methodology on first visit, 6 and 12 months.CKD patients were grouped based on dietary phosphorus intake:Group 1 (n 42): phosphorous intake <1000mg/day and Group 2 (n=37; 17 in CKD 1; 20 CKD 2): high phosphorous intake (>1000mg/d).Patients in Group 2 were counselled for low phosphorus diet.

Results

Parameters of controls and CKD patients differed significantly. Dietary, serum and urinary phosphorus (0.001) had significant association. Systolic and diastolic BP, protein intake, dietary phosphorus, iPTH, FGF23 were significantly high (p 0.001) and Klotho significantly low(p 0.001) in Group 2 compared to Group 1,. Impact of dietary intervention was seen at 6 and 12 months as reduction in protein intake from 0.64±0.95 to 0.58±0.11 (CKD 1) and 0.71±0.074 to 0.64±0.095 (p 0.012 CKD 2); decline in creatinine from 1.13±0.14 to 1.07±0.14 (CKD 1) and 1.06±8.56 (p 0.009 CKD 1); serum phosphorus from 3.57±0.19 to 3.23±0.58 (CKD 1) and 4.32±0.42 to 3.35±0.85 mg/dL (p 0.001 CKD 2), FGF-23 from 55.01±1.65, to 51.27±11.17 (CKD 1); 65.42±4.80 to 56.60±11.23 (p 0.010 CKD 2); systolic BP from 127.95±3.14 to 121.05±14.40(CKD 1); 134.22±3.54 to 118.38±9.08 (p 0.001 CKD 2) and diastolic BP from 85.14±3.40 to 83.29±8.03(CKD 1); 89.11±4.74 to 80.33±8.02 (p 0.003 CKD 2) and a significant increase in eGFR ml/min from 95.17±5.50 to 97.75±20.26 (CKD 1); 69.82±8.56 to 74.08±11.07 (p 0.019 CKD 2)was observed. sKlotho increased from 700.79±27.82 to 897.39±168.37 (p0.001 CKD 1); from 633.52±60.56 to 823.37±156.67 (p 0.001 CKD 2). Ca x P product declined from 36.10±4.84 to 29.48±7.63 (p0.001). eGFR can predicted using dietary protein, creatinine systolic BP, haemoglobin, cholesterol (r2 0.868).

Conclusion

Dietary counselling had significant effect on all the parameters in early CKD stages.Dietary intervention can preventrise in FGF23, reduce blood pressure and prevent decline in renal function as demonstrated by significant increase in eGFR with phosphorus restriction in early stages of CKD.