Spontaneously Low Protein Intake in Elderly CKD Patients: Myth or Reality? Analysis of Baseline Protein Intake in a Large Cohort of Patients with Advanced CKD
The recent guidelines on nutritional management of chronic kidney disease (CKD) advise a reduction in protein intake as early as CKD stage 3, regardless of age, to slow kidney function impairment. However, since elderly patients are usually considered as having a spontaneously reduced protein intake...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/13/12/4371 |
| _version_ | 1797501752014012416 |
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| author | Massimo Torreggiani Antioco Fois Maria Rita Moio Antoine Chatrenet Béatrice Mazé Françoise Lippi Jerome Vigreux Coralie Beaumont Giulia Santagati Noemi Paulin Giorgina Barbara Piccoli |
| author_facet | Massimo Torreggiani Antioco Fois Maria Rita Moio Antoine Chatrenet Béatrice Mazé Françoise Lippi Jerome Vigreux Coralie Beaumont Giulia Santagati Noemi Paulin Giorgina Barbara Piccoli |
| author_sort | Massimo Torreggiani |
| collection | DOAJ |
| description | The recent guidelines on nutritional management of chronic kidney disease (CKD) advise a reduction in protein intake as early as CKD stage 3, regardless of age, to slow kidney function impairment. However, since elderly patients are usually considered as having a spontaneously reduced protein intake, nutritional interventions to reduce protein intake are often considered futile. This study aimed to assess the baseline protein intake of elderly CKD patients referred for nephrology care, and explore the need for dietary evaluations, focusing on the current recommendations for protein restriction in CKD. This is an observational study of CKD patients followed in the unit dedicated to advanced CKD patients in Le Mans, France. Patients with stages 3 to 5 not on dialysis were included. All patients were evaluated by an expert dietician to assess their baseline protein intake, whenever possible on the basis of a 7-days diet journal; when this was not available, dietary recall or analysis of delivered meals was employed. Demographic characteristics, underlying kidney disease, Charlson Comorbidity Index (CCI), Malnutrition-Inflammation Score (MIS), Subjective Global Assessment (SGA) and clinical and laboratory data were recorded. Between 15 November 2017 and 31 December 2020, 436 patients were evaluated in the unit. Their age distribution was as follows: “young”: <60 (<i>n</i> = 62), “young-old”: 60–69 (<i>n</i> = 74), “old”: 70–79 (<i>n</i> = 108), “old-old”: 80–89 (<i>n</i> = 140) and “oldest-old”: ≥90 (<i>n</i> = 54). The prevalence of vascular nephropathies was higher in patients older than 70 years compared to younger ones, as did CCI and MIS (<i>p</i> < 0.001). Moderate nutritional impairment (SGA: B) was higher in elderly patients, reaching 53.7% at ≥90, while less than 3% of patients in the overall cohort were classified as SGA C (<i>p</i> < 0.001). The median protein intake was higher than the recommended one of 0.8 g/kg/day in all age groups; it was 1.2 g/kg/day in younger patients and 1.0 thereafter (<i>p</i> < 0.001). Patient survival depended significantly on age (<i>p</i> < 0.001) but not on baseline protein intake (<i>p</i> = 0.63), and younger patients were more likely to start dialysis during follow-up (<i>p</i> < 0.001). Over half of the patients, including the old-old and oldest-old, were still on follow-up two years after referral and it was found that survival was only significantly associated with age and comorbidity and was not affected by baseline protein intake. Our study shows that most elderly patients, including old-old and extremely old CKD patients, are spontaneously on diets whose protein content is higher than recommended, and indicates there is a need for nutritional care for this population. |
| first_indexed | 2024-03-10T03:23:03Z |
| format | Article |
| id | doaj.art-141a500f9bf8418da9e45f3178637286 |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-10T03:23:03Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-141a500f9bf8418da9e45f31786372862023-11-23T09:56:46ZengMDPI AGNutrients2072-66432021-12-011312437110.3390/nu13124371Spontaneously Low Protein Intake in Elderly CKD Patients: Myth or Reality? Analysis of Baseline Protein Intake in a Large Cohort of Patients with Advanced CKDMassimo Torreggiani0Antioco Fois1Maria Rita Moio2Antoine Chatrenet3Béatrice Mazé4Françoise Lippi5Jerome Vigreux6Coralie Beaumont7Giulia Santagati8Noemi Paulin9Giorgina Barbara Piccoli10Néphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceNéphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceNéphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceNéphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceNéphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceNéphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceNéphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceNéphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceNéphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceNéphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceNéphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, FranceThe recent guidelines on nutritional management of chronic kidney disease (CKD) advise a reduction in protein intake as early as CKD stage 3, regardless of age, to slow kidney function impairment. However, since elderly patients are usually considered as having a spontaneously reduced protein intake, nutritional interventions to reduce protein intake are often considered futile. This study aimed to assess the baseline protein intake of elderly CKD patients referred for nephrology care, and explore the need for dietary evaluations, focusing on the current recommendations for protein restriction in CKD. This is an observational study of CKD patients followed in the unit dedicated to advanced CKD patients in Le Mans, France. Patients with stages 3 to 5 not on dialysis were included. All patients were evaluated by an expert dietician to assess their baseline protein intake, whenever possible on the basis of a 7-days diet journal; when this was not available, dietary recall or analysis of delivered meals was employed. Demographic characteristics, underlying kidney disease, Charlson Comorbidity Index (CCI), Malnutrition-Inflammation Score (MIS), Subjective Global Assessment (SGA) and clinical and laboratory data were recorded. Between 15 November 2017 and 31 December 2020, 436 patients were evaluated in the unit. Their age distribution was as follows: “young”: <60 (<i>n</i> = 62), “young-old”: 60–69 (<i>n</i> = 74), “old”: 70–79 (<i>n</i> = 108), “old-old”: 80–89 (<i>n</i> = 140) and “oldest-old”: ≥90 (<i>n</i> = 54). The prevalence of vascular nephropathies was higher in patients older than 70 years compared to younger ones, as did CCI and MIS (<i>p</i> < 0.001). Moderate nutritional impairment (SGA: B) was higher in elderly patients, reaching 53.7% at ≥90, while less than 3% of patients in the overall cohort were classified as SGA C (<i>p</i> < 0.001). The median protein intake was higher than the recommended one of 0.8 g/kg/day in all age groups; it was 1.2 g/kg/day in younger patients and 1.0 thereafter (<i>p</i> < 0.001). Patient survival depended significantly on age (<i>p</i> < 0.001) but not on baseline protein intake (<i>p</i> = 0.63), and younger patients were more likely to start dialysis during follow-up (<i>p</i> < 0.001). Over half of the patients, including the old-old and oldest-old, were still on follow-up two years after referral and it was found that survival was only significantly associated with age and comorbidity and was not affected by baseline protein intake. Our study shows that most elderly patients, including old-old and extremely old CKD patients, are spontaneously on diets whose protein content is higher than recommended, and indicates there is a need for nutritional care for this population.https://www.mdpi.com/2072-6643/13/12/4371low-protein dietCKDelderlyprotein intakesurvival |
| spellingShingle | Massimo Torreggiani Antioco Fois Maria Rita Moio Antoine Chatrenet Béatrice Mazé Françoise Lippi Jerome Vigreux Coralie Beaumont Giulia Santagati Noemi Paulin Giorgina Barbara Piccoli Spontaneously Low Protein Intake in Elderly CKD Patients: Myth or Reality? Analysis of Baseline Protein Intake in a Large Cohort of Patients with Advanced CKD Nutrients low-protein diet CKD elderly protein intake survival |
| title | Spontaneously Low Protein Intake in Elderly CKD Patients: Myth or Reality? Analysis of Baseline Protein Intake in a Large Cohort of Patients with Advanced CKD |
| title_full | Spontaneously Low Protein Intake in Elderly CKD Patients: Myth or Reality? Analysis of Baseline Protein Intake in a Large Cohort of Patients with Advanced CKD |
| title_fullStr | Spontaneously Low Protein Intake in Elderly CKD Patients: Myth or Reality? Analysis of Baseline Protein Intake in a Large Cohort of Patients with Advanced CKD |
| title_full_unstemmed | Spontaneously Low Protein Intake in Elderly CKD Patients: Myth or Reality? Analysis of Baseline Protein Intake in a Large Cohort of Patients with Advanced CKD |
| title_short | Spontaneously Low Protein Intake in Elderly CKD Patients: Myth or Reality? Analysis of Baseline Protein Intake in a Large Cohort of Patients with Advanced CKD |
| title_sort | spontaneously low protein intake in elderly ckd patients myth or reality analysis of baseline protein intake in a large cohort of patients with advanced ckd |
| topic | low-protein diet CKD elderly protein intake survival |
| url | https://www.mdpi.com/2072-6643/13/12/4371 |
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