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Nutrients 2019, 11(1), 121; https://doi.org/10.3390/nu11010121

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

1
Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea
2
Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul 06591, Korea
3
Department of Internal Medicine, Inje University, Busan Paik Hospital, Busan 47392, Korea
4
Department of Internal Medicine, Gachon University, Gil Hospital, Incheon 21565, Korea
5
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03082, Korea
6
Cancer Research Institute, Seoul National University, Seoul 08826, Korea
7
Department of Biomedical Science, Seoul National University Graduate School, Seoul 03081, Korea
8
Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul 03722, Korea
9
Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
*
Author to whom correspondence should be addressed.
Received: 3 December 2018 / Revised: 11 December 2018 / Accepted: 4 January 2019 / Published: 8 January 2019
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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. View Full-Text
Keywords: dietary protein intake; protein energy wasting; chronic kidney disease; progression; nutrition dietary protein intake; protein energy wasting; chronic kidney disease; progression; nutrition
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Lee, S.W.; Kim, Y.-S.; Kim, Y.H.; Chung, W.; Park, S.K.; Choi, K.H.; Ahn, C.; Oh, K.-H. Dietary Protein Intake, Protein Energy Wasting, and the Progression of Chronic Kidney Disease: Analysis from the KNOW-CKD Study. Nutrients 2019, 11, 121.

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