Low Protein Nitrogen Appearance as a Surrogate of Low Dietary Protein Intake Is Associated with Higher All-Cause Mortality in Maintenance Hemodialysis Patients
To determine the association between all-cause mortality and dietary protein intake in patients with chronic kidney disease, we performed a large-scale, 8-y prospective cohort study in 98,489 maintenance hemodialysis patients from a multicenter dialysis care provider. Compared with the reference lev...
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Published in | The Journal of nutrition Vol. 143; no. 7; pp. 1084 - 1092 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Bethesda, MD
American Society for Nutrition
01.07.2013
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Subjects | |
Online Access | Get full text |
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Abstract | To determine the association between all-cause mortality and dietary protein intake in patients with chronic kidney disease, we performed a large-scale, 8-y prospective cohort study in 98,489 maintenance hemodialysis patients from a multicenter dialysis care provider. Compared with the reference level (60 to <70 g/d), low protein nitrogen appearance (PNA) levels [<30 g/d, HR: 1.40 (95% CI: 1.30, 1.50); 30 to <40 g/d, HR: 1.33 (95% CI: 1.28, 1.39)] was associated with higher all-cause mortality, and high PNA levels [≥110 g/d, HR: 0.92 (95% CI: 0.88, 0.97); 100 to <110 g/d, HR: 0.87 (95% CI: 0.82, 0.91)] were associated with lower all-cause mortality in all analyses. This association was also found in subanalyses performed among racial and hypoalbuminemic groups. Hence, using PNA as a surrogate for protein intake, a low daily dietary protein intake is associated with increased risk of death in all hemodialysis patients. Whether the association between dietary protein intake and survival is causal or a consequence of anorexia secondary to protein-energy-wasting/inflammation or other factors should be explored in interventional trials. |
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AbstractList | To determine the association between all-cause mortality and dietary protein intake in patients with chronic kidney disease, we performed a large-scale, 8-y prospective cohort study in 98,489 maintenance hemodialysis patients from a multicenter dialysis care provider. Compared with the reference level (60 to <70 g/d), low protein nitrogen appearance (PNA) levels [<30 g/d, HR: 1.40 (95% CI: 1.30, 1.50); 30 to <40 g/d, HR: 1.33 (95% CI: 1.28, 1.39)] was associated with higher all-cause mortality, and high PNA levels [≥110 g/d, HR: 0.92 (95% CI: 0.88, 0.97); 100 to <110 g/d, HR: 0.87 (95% CI: 0.82, 0.91)] were associated with lower all-cause mortality in all analyses. This association was also found in subanalyses performed among racial and hypoalbuminemic groups. Hence, using PNA as a surrogate for protein intake, a low daily dietary protein intake is associated with increased risk of death in all hemodialysis patients. Whether the association between dietary protein intake and survival is causal or a consequence of anorexia secondary to protein-energy-wasting/inflammation or other factors should be explored in interventional trials. |
Author | KOPPLE, Joel D VICTOROFF, Alla NORRIS, Keith C STREJA, Elani RAVEL, Vanessa A JENNIE JING KOVESDY, Csaba P BENNER, Debbie JUN CHUL KIM KALANTAR-ZADEH, Kamyar MOLNAR, Miklos Z |
Author_xml | – sequence: 1 givenname: Vanessa A surname: RAVEL fullname: RAVEL, Vanessa A organization: Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine, CA, United States – sequence: 2 givenname: Miklos Z surname: MOLNAR fullname: MOLNAR, Miklos Z organization: Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine, CA, United States – sequence: 3 givenname: Kamyar surname: KALANTAR-ZADEH fullname: KALANTAR-ZADEH, Kamyar organization: Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine, CA, United States – sequence: 4 givenname: Elani surname: STREJA fullname: STREJA, Elani organization: Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine, CA, United States – sequence: 5 surname: JUN CHUL KIM fullname: JUN CHUL KIM organization: Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine, CA, United States – sequence: 6 givenname: Alla surname: VICTOROFF fullname: VICTOROFF, Alla organization: Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine, CA, United States – sequence: 7 surname: JENNIE JING fullname: JENNIE JING organization: Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine, CA, United States – sequence: 8 givenname: Debbie surname: BENNER fullname: BENNER, Debbie organization: DaVita, Inc., Denver, CO, United States – sequence: 9 givenname: Keith C surname: NORRIS fullname: NORRIS, Keith C organization: David Geffen School of Medicine at UCLA, Los Angeles, CA, United States – sequence: 10 givenname: Csaba P surname: KOVESDY fullname: KOVESDY, Csaba P organization: Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, TN, United States – sequence: 11 givenname: Joel D surname: KOPPLE fullname: KOPPLE, Joel D organization: Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, CA, United States |
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Title | Low Protein Nitrogen Appearance as a Surrogate of Low Dietary Protein Intake Is Associated with Higher All-Cause Mortality in Maintenance Hemodialysis Patients |
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