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Nutrients. 2019;11(1):nu11010121.

Dietary Protein Intake, Protein Energy Wasting, and the Progression of Chronic Kidney Disease: Analysis from the KNOW-CKD Study.

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제1저자 이성우 · 교신저자 오국환

소속 (10)
  1. Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea. neplsw@gmail.com.
  2. Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul 06591, Korea. kimcmc@catholic.ac.kr.
  3. Department of Internal Medicine, Inje University, Busan Paik Hospital, Busan 47392, Korea. yeonghnl@inje.ac.kr.
  4. Department of Internal Medicine, Gachon University, Gil Hospital, Incheon 21565, Korea. jwkpsj79@hanmail.net.
  5. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03082, Korea. suepark@snu.ac.kr.
  6. Cancer Research Institute, Seoul National University, Seoul 08826, Korea. suepark@snu.ac.kr.
  7. Department of Biomedical Science, Seoul National University Graduate School, Seoul 03081, Korea. suepark@snu.ac.kr.
  8. Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul 03722, Korea. khchoi6@yumc.yonsei.ac.kr.
  9. Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea. curie@snu.ac.kr.
  10. Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea. ohchris@hanmail.net.

Abstract

Studies on the effect of dietary protein intake (DPI) on chronic kidney disease (CKD) progression, along with the potential hazard of protein-energy wasting (PEW), are scarce. We evaluated the association between DPI and kidney function both cross-sectionally and longitudinally, particularly emphasizing the role of PEW, in a large-scale, observational, multicenter, prospective study. We enrolled 1572 patients with non-dialysis CKD between 2011 and 2016. CKD progression was defined by a >50% estimated glomerular filtration rate (eGFR) decrease, serum creatinine doubling, or dialysis initiation. A Cox proportional hazard regression analysis was conducted. During the mean follow-up period of 41.6 months, CKD progression was observed in 296 patients. Cross-sectionally, increased DPI was significantly associated with increased eGFR. Similarly, increased DPI tertile was significantly associated with increased renal survival in a Kaplan⁻Meier curve analysis. In the multivariate Cox proportional hazard regression analysis, the statistical significance of the DPI tertile group in CKD progression was lost when PEW-related variables were added as covariates. In penalized spline curve analysis, the adjusted odds ratio of PEW significantly increased as DPI decreased. DPI, per se was not a major determinant of CKD progression. An intimate association between reduced DPI and PEW may be a more important predictor of CKD progression than DPI.

Keywords

chronic kidney diseasedietary protein intakenutritionprogressionprotein energy wasting

Figures

Figure 1
Figure 1 Generalized additive model (GAM) plot for Gaussian distribution between dietary protein intake (DPI) and estimated glomerular filtration rate (eGFR). The solid and dashed lines are the spline curve and its 95% confidence intervals, respectively. The upper (≥2.36 g/kg/day) and lower 1% (<0.5 g/kg/day) of DPI were truncated. The covariates in the multivariate GAM analysis were age, sex, current smoking, alcohol drinking, hypertension, diabetes, causes of chronic kidney disease, urine protein to creatinine ratio, blood urea nitrogen, bilirubin, hemoglobin, body mass index, cholesterol, estimated skeletal muscle mass, and serum albumin.
Figure 2
Figure 2 Kaplan–Meier survival curve of tertiles of dietary protein intake (DPI). * and † indicate p < 0.05 when compared to the first and second tertiles of the DPI group, respectively, using the log-rank test.
Figure 3
Figure 3 Penalized smoothing splines showing the relationship between DPI and PEW. DPI, dietary protein intake; PEW, protein energy wasting; OR, odds ratio; CI, confidence interval; T, tertile. The upper (≥2.36 g/kg/day) and lower 1% (<0.5 g/kg/day) of DPI were truncated. The red line indicates the OR and the black dotted line indicates the 95% CI for which DPI influences PEW components by three or more. OR and 95% CI were analyzed using a multivariate logistic regression analysis including age, sex, current smoking, alcohol drinking, hypertension, diabetes, causes of chronic kidney disease, urine protein to creatinine ratio, blood urea nitrogen, estimated glomerular filtration rate, bilirubin, hemoglobin, and high sensitivity C-reactive protein.

그림 출처: PubMed Central 공개 논문 (PMC6356719)

Conflict of interest statement

The authors declare no conflict of interest.

그 밖의 정보
출판 형태
Journal Article
저널
Nutrients · eISSN 2072-6643
전자 출판
2019-01-08
MeSH
Creatinine / blood · Cross-Sectional Studies · Diet* · Dietary Proteins / administration & dosage · Disease Progression · Feeding Behavior* · Female · Glomerular Filtration Rate · Humans · Kaplan-Meier Estimate · Kidney / pathology / physiopathology · Longitudinal Studies · Male · Middle Aged · Odds Ratio · Proportional Hazards Models · Prospective Studies · Protein-Energy Malnutrition / complications · Renal Dialysis* · Renal Insufficiency · Renal Insufficiency, Chronic / blood / physiopathology / therapy
Substances
Dietary Proteins · Creatinine
연구비
Korea Centers for Disease Control & Prevention 2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, and 2016E3300200
참고문헌
43편