Strict dietary protein restriction may do more harm than good for some patients with chronic kidney disease (CKD), according to a prospective cohort study published in JAMA Network Open.
Patients with nondialysis CKD whose daily protein intake (DPI) fell below 0.6 g/kg/d had an approximately 42% higher risk of kidney failure requiring replacement therapy (KFRT) and more than double the risk of all-cause mortality compared with those consuming 1.2 g/kg/d or more, a finding pharmacists may want to keep in mind when patients describe aggressive self-directed diet changes.1The authors noted that protein restriction has long been a cornerstone of CKD management, but its long-term benefits remain unclear in Asian populations, who often have lower body mass and muscle reserves.
A key concern is protein-energy wasting (PEW), a condition highly prevalent in patients with CKD that leads to muscle loss and nutritional imbalance.1Study DesignInvestigators analyzed data from the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD), which enrolled patients with CKD stages 1 to predialysis 5 from 9 tertiary hospitals in South Korea between 2011 and 2016.
DPI was estimated objectively from 24-hour urinary urea nitrogen excretion at baseline, and participants were grouped into 5 categories, from less than 0.6 g/kg/d to 1.2 g/kg/d or greater.
The primary outcome was KFRT, and Fine-Gray models accounted for the competing risk of death.1A total of 1861 participants (mean [SD] age, 53.7 [12.0] years) were followed for a median of 9.3 years.1
Strict dietary protein restriction may do more harm than good for some patients with chronic kidney disease (CKD), according to a prospective cohort study published in JAMA Network Open. Patients with nondialysis CKD whose daily protein intake (DPI) fell below 0.6 g/kg/d had an approximately 42% higher risk of kidney failure requiring replacement therapy (KFRT) and more than double the risk of all-cause mortality compared with those consuming 1.2 g/kg/d or more, a finding pharmacists may want to keep in mind when patients describe aggressive self-directed diet changes.1
The authors noted that protein restriction has long been a cornerstone of CKD management, but its long-term benefits remain unclear in Asian populations, who often have lower body mass and muscle reserves. A key concern is protein-energy wasting (PEW), a condition highly prevalent in patients with CKD that leads to muscle loss and nutritional imbalance.1
Study Design
Investigators analyzed data from the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD), which enrolled patients with CKD stages 1 to predialysis 5 from 9 tertiary hospitals in South Korea between 2011 and 2016. DPI was estimated objectively from 24-hour urinary urea nitrogen excretion at baseline, and participants were grouped into 5 categories, from less than 0.6 g/kg/d to 1.2 g/kg/d or greater. The primary outcome was KFRT, and Fine-Gray models accounted for the competing risk of death.1
A total of 1861 participants (mean [SD] age, 53.7 [12.0] years) were followed for a median of 9.3 years.1
