The safety of a low-protein diet in older adults with advanced chronic kidney disease.

IF 4.8 2区 医学 Q1 TRANSPLANTATION Nephrology Dialysis Transplantation Pub Date : 2024-10-30 DOI:10.1093/ndt/gfae077
Karin Windahl, Nicholas C Chesnaye, Gerd Faxén Irving, Peter Stenvinkel, Tora Almquist, Maarit Korkeila Lidén, Christiane Drechsler, Maciej Szymczak, Magdalena Krajewska, Esther de Rooij, Claudia Torino, Gaetana Porto, Fergus J Caskey, Christoph Wanner, Kitty J Jager, Friedo W Dekker, Marie Evans
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Abstract

Background: A low-protein diet (LPD) is recommended to patients with advanced chronic kidney disease (CKD), whereas geriatric guidelines recommend a higher amount of protein. The aim of this study was to evaluate the safety of LPD treatment in older adults with advanced CKD.

Methods: The EQUAL study is a prospective, observational study including patients ≥65 years of age with an incident estimated glomerular filtration rate <20 ml/min/1.73 m2 in six European countries with follow-up through 6 years. Nutritional status was assessed by a 7-point subjective global assessment (SGA) every 3-6 months. Prescribed diet (g protein/kg of bodyweight) was recorded on every study visit; measured protein intake was available in three countries. Time to death and decline in nutritional status (SGA decrease of ≥2 points) were analysed using marginal structural models with dynamic inverse probability of treatment and censoring weights.

Results: Of 1738 adults (631 prescribed LPD at any point during follow-up), there were 1319 with repeated SGA measurements, of which 267 (20%) decreased in SGA ≥2 points and 565 (32.5%) who died. There was no difference in survival or decrease in nutritional status for patients prescribed a LPD ≤0.8 g/kg ideal bodyweight {odds ratio [OR] for mortality 1.15 [95% confidence interval (CI) 0.86-1.55)] and OR for decrease in SGA 1.11 [95% CI 0.74-1.66]} in the adjusted models. In patients prescribed a LPD <0.6 g/kg ideal bodyweight, the results were similar. There was a significant interaction with LPD and older age >75 years, lower SGA and higher comorbidity burden for both mortality and nutritional status decline.

Conclusions: In older adults with CKD approaching end-stage kidney disease, a traditional LPD prescribed and monitored according to routine clinical practice in Europe appears to be safe.

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晚期慢性肾病老年人低蛋白饮食的安全性。
背景:低蛋白饮食(LPD)被推荐给晚期慢性肾脏病(CKD)患者,而老年病指南则推荐较高的蛋白质量。本研究旨在评估晚期慢性肾脏病老年人接受低蛋白饮食治疗的安全性:EQUAL 研究是一项前瞻性观察研究,包括年龄≥65 岁的患者、事件估计肾小球滤过率:在 1738 名成人中(631 人在随访期间的任何时候服用了 LPD),有 1319 人重复测量了 SGA,其中 267 人(20%)的 SGA 下降了 2 个百分点,565 人(32.5%)死亡。在调整模型中,LPD ≤0.8 g/kg 理想体重的患者在存活率和营养状况下降方面没有差异(死亡率的比值比(OR)为 1.15(95% 置信区间(CI)为 0.86-1.55),SGA 下降的比值比(OR)为 1.11(95% 置信区间(CI)为 0.74-1.66)。在开具 LPD 75 年处方的患者中,SGA 较低,死亡率和营养状况下降的合并症负担较高:对于濒临终末期肾病的老年 CKD 患者,根据欧洲常规临床实践开具和监测的传统 LPD 似乎是安全的。
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来源期刊
Nephrology Dialysis Transplantation
Nephrology Dialysis Transplantation 医学-泌尿学与肾脏学
CiteScore
10.10
自引率
4.90%
发文量
1431
审稿时长
1.7 months
期刊介绍: Nephrology Dialysis Transplantation (ndt) is the leading nephrology journal in Europe and renowned worldwide, devoted to original clinical and laboratory research in nephrology, dialysis and transplantation. ndt is an official journal of the [ERA-EDTA](http://www.era-edta.org/) (European Renal Association-European Dialysis and Transplant Association). Published monthly, the journal provides an essential resource for researchers and clinicians throughout the world. All research articles in this journal have undergone peer review. Print ISSN: 0931-0509.
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