Association between Low Dietary Protein Intake and Geriatric Nutrition Risk Index in Patients with Chronic Kidney Disease: A Retrospective Single-Center Cohort Study

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Aki Kiuchi ; Yasushi Ohashi ; Reibin Tai ; Toshiyuki Aoki ; Sonoo Mizuiri ; Toyoko Ogura ; Atsushi Aikawa ; Ken Sakai (2016)
  • Publisher: MDPI AG
  • Journal: Nutrients, volume 8, issue 10 (issn: 2072-6643, eissn: 2072-6643)
  • Related identifiers: doi: 10.3390/nu8100662, pmc: PMC5084048
  • Subject: Nutrition. Foods and food supply | body composition | chronic kidney disease | nutritional status | TX341-641 | body mass index | geriatric nutritional risk index | wasting syndrome | serum albumin | Article | food intake

Reduced dietary protein intake in malnourished patients with chronic kidney disease (CKD) may be associated with adverse clinical outcomes, which may mask any efficacy of a low-protein diet. The study included 126 patients with CKD who attended a dedicated dietary counseling clinic in 2005–2009 and were systematically followed until January 2015. Of these patients, 20 (15.9%) had moderate or severe nutrition-related risk of geriatric nutritional risk index (GNRI) < 92; these patients were more likely to be older, have a greater proteinuria, and have lower body mass index and serum albumin concentration. Dietary protein intake was significantly lower in older patients (r = −0.33, p < 0.001) and those with lower glomerular filtration rate (r = 0.47, p < 0.001). The non-protein to nitrogen calorie ratio was independently associated with GNRI. Reduced GNRI was significantly associated with mortality (hazard ratio (HR) = 4.94; 95% confidence interval (CI) = 1.61–15.42, p = 0.012) and cardiovascular events (HR = 9.37; 95% CI = 2.49–37.34, p = 0.006), but not with adverse renal outcomes. Restricting protein intake may be harmful to patients with any nutrition-related risk, suggesting that improvement of nutritional status should be a high priority.
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