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Kidney Week

Abstract: PO1729

Association of Muscle Mass and Protein Intake with Risk of ESKD in Patients with CKD

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Ibrahim, Atif, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Mettupalli, Neeharika, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Hassan, Waleed, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Obi, Yoshitsugu, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Mohamed, Mahmoud Magdy, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Molnar, Miklos Zsolt, University of Utah Health, Salt Lake City, Utah, United States
  • Wall, Barry M., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Better nutritional status is favorably associated with clinical outcomes, but high protein intake may have deleterious effects on kidney function by virtue of mechanisms unrelated to nutritional status. We hypothesized that dietary protein intake and muscle mass (two markers of nutritional status) have opposite associations with progression of CKD when examined together.

Methods

We examined a cohort of 702 US veterans with stage 3-5 CKD followed at a single institution. We used spot urea nitrogen (UUN) and urine creatinine (UC) and adjusted for urine specific gravity as surrogates of dietary protein intake and muscle mass, respectively. We examined the concomitant association of UUN and UC with ESKD using multivariable adjusted competing-risks regression with adjustment for demographic characteristics, comorbidities, eGFR, proteinuria, smoking status, and body mass index.

Results

Patients were 68±10 years old, 96% were male, 60% were African American and their baseline eGFR was 32±13 mL/min/1.73 m2. There were 178 ESKD events (event rate, 72.8/1000 PY; 95%CI, 62.8-84.4) over a median follow-up of 3.5 years. In a multivariable adjusted model including both nutritional markers, higher UUN was associated with a higher risk of ESKD (subhazard ratio [SHR] and 95%CI associated with 100 mg/dl higher UUN: 1.15, 1.00-1.35), while UC was associated with a lower risk of ESKD (SHR and 95%CI associated with one standard deviation higher UC: 0.50, 0.32-0.78) [Figure].

Conclusion

Higher protein intake is associated with higher risk of ESKD, while higher muscle mass is associated with a lower risk of ESKD in patients with stage 3-5 CKD. While observational in nature, these results suggest that renoprotection with dietary protein restriction should be pursued with close attention to maintaining optimal nutritional status.