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Abstract: SA-PO376

Dietary Protein Intake and Coronary Artery Calcification Changes Over Time in a Prospective Hemodialysis Cohort

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Okazaki, Masaki, University of California Irvine, Irvine, United States
  • Narasaki, Yoko, University of California Irvine, Irvine, California, United States
  • Rhee, Connie, University of California Irvine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States

Hemodialysis (HD) patients are recommended a targeted protein intake of 1.0-1.2 g/kg/day. Increasing dietary protein intake while maintaining total daily food intake can be compensated by increasing the ratio of total protein per energy, and a higher ratio may be sought to achieve by increasing animal protein content. This study aimed to examine the relationship between dietary protein intake as a percentage to daily energy intake and their association with coronary artery calcification (CAC) and its changes over time in HD patients.


In a secondary analysis of 93 participants from the Anti-Inflammatory and Anti-Oxidative Nutrition in Hypoalbuminemic Dialysis Patients (AIONID) trial, we examined the association of total dietary protein to energy percentage assessed by 3-day food records with log-transformed annualized change in Agatston CAC score. Linear regression model was used for the comparison of tertile groups, and restricted cubic splines were fitted for continuous model.


Analytic cohort of 70 patients with 2-point CAC measurements were categorized into tertiles according to the percentage of total protein to energy intake. Mean±SD age was 59.1±12.8 years. There were statistically significant trends toward higher plant protein proportion across lower total protein to energy proportion. Compared to the reference of the lowest tertile protein ratio group, middle tertile protein group exhibited a positive slope of ln[CAC score+1] (β=0.93, 95% CI: 0.18 to 1.56, p=0.007). In continuous spline models, we observed reverse U-shaped association of protein to energy proportion with CAC progression.


Compared to the group with the lowest tertile of dietary protein to energy intake ratio, the middle tertile group was associated with a higher risk of CAC progression. Our findings may indicate that the modulating dietary protein intake by increasing quantity without modulating quality including proportion of animal vs plant protein may not achieve the goal of preventing vascular calcification.