Rakesh Malhotra1, Loren Lipworth2, Kerri L Cavanaugh3, Bessie A Young4, Katherine L Tucker5, Teresa C Carithers6, Herman A Taylor7, Adolfo Correa8, Edmond K Kabagambe2, T Alp Ikizler3. 1. Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California. Electronic address: r3malhotra@ucsd.edu. 2. Vanderbilt Center for Kidney Disease, Nashville, Tennessee; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Jackson Heart Study Vanguard Center at Vanderbilt University Medical Center, Nashville, Tennessee. 3. Vanderbilt Center for Kidney Disease, Nashville, Tennessee; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 4. Division of Nephrology, Department of Medicine, VA Puget Sound Health Care System, Kidney Research Institute, University of Washington, Seattle, Washington. 5. Biomedical and Nutritional Sciences, Center for Population Health, University of Massachusetts Lowell, Lowell, Massachusetts. 6. School of Applied Sciences, Nutrition and Hospitality Management, University of Mississippi, Jackson, Mississippi. 7. Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia. 8. Department of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, Mississippi.
Abstract
OBJECTIVE: Dietary protein intake could have deleterious renal effects in populations at risk for chronic kidney disease. Here, we examined whether higher protein intake (≥80th percentile of energy from protein) is associated with decline in kidney function and whether this decline varies by diabetes status. DESIGN: Observational cohort study. SUBJECTS AND SETTINGS: Participants were African-Americans (n = 5,301), who enrolled in the Jackson Heart Study between 2000 and 2004. METHODS: Dietary intake was assessed using a validated food-frequency questionnaire at baseline, and serum creatinine was measured at baseline (visit 1) and 8 years later (visit 3). Estimated glomerular filtration rates (eGFRs) at baseline and follow-up were computed using the chronic kidney disease epidemiology collaboration equation. MAIN OUTCOME MEASURE: The change in eGFR was computed by subtracting eGFR at visit 1 from that at visit 3. RESULTS: Of 3,165 participants with complete data, 64% were women, 57% had hypertension, and 19% had diabetes. The median (25th, 75th percentile) percent energy intake from protein was 14.3 (12.4, 16.4), comparable to that reported for the general US population (15% of energy). During a median (25th, 75th percentile) follow-up of 8.0 (7.4, 8.3) years, eGFR declined by 10.5% from a mean (SD) of 97.4 (17.5) to 86.9 (21.3) mL/min/1.73 m2. In the fully adjusted model, consumption of protein as percent of energy intake in lowest and highest quintiles was associated with decline in eGFR among diabetic subjects. The analysis of variance with a robust variance estimator was used to determine whether long-term change in eGFR significantly varies by protein intake. CONCLUSIONS: Our results show that, among African-Americans with diabetes, higher protein intake as a percent of total energy intake is positively associated with greater decline in eGFR in analyses that accounted for risk factors for kidney disease.
OBJECTIVE: Dietary protein intake could have deleterious renal effects in populations at risk for chronic kidney disease. Here, we examined whether higher protein intake (≥80th percentile of energy from protein) is associated with decline in kidney function and whether this decline varies by diabetes status. DESIGN: Observational cohort study. SUBJECTS AND SETTINGS: Participants were African-Americans (n = 5,301), who enrolled in the Jackson Heart Study between 2000 and 2004. METHODS: Dietary intake was assessed using a validated food-frequency questionnaire at baseline, and serum creatinine was measured at baseline (visit 1) and 8 years later (visit 3). Estimated glomerular filtration rates (eGFRs) at baseline and follow-up were computed using the chronic kidney disease epidemiology collaboration equation. MAIN OUTCOME MEASURE: The change in eGFR was computed by subtracting eGFR at visit 1 from that at visit 3. RESULTS: Of 3,165 participants with complete data, 64% were women, 57% had hypertension, and 19% had diabetes. The median (25th, 75th percentile) percent energy intake from protein was 14.3 (12.4, 16.4), comparable to that reported for the general US population (15% of energy). During a median (25th, 75th percentile) follow-up of 8.0 (7.4, 8.3) years, eGFR declined by 10.5% from a mean (SD) of 97.4 (17.5) to 86.9 (21.3) mL/min/1.73 m2. In the fully adjusted model, consumption of protein as percent of energy intake in lowest and highest quintiles was associated with decline in eGFR among diabetic subjects. The analysis of variance with a robust variance estimator was used to determine whether long-term change in eGFR significantly varies by protein intake. CONCLUSIONS: Our results show that, among African-Americans with diabetes, higher protein intake as a percent of total energy intake is positively associated with greater decline in eGFR in analyses that accounted for risk factors for kidney disease.
Authors: Vladimir Vukovic; Essi Hantikainen; Athina Raftopoulou; Martin Gögele; Johannes Rainer; Francisco S Domingues; Peter P Pramstaller; Vanessa Garcia-Larsen; Cristian Pattaro Journal: J Nephrol Date: 2022-08-05 Impact factor: 4.393
Authors: Stanley M H Yeung; Antonio W Gomes-Neto; Maryse C J Osté; Else van den Berg; Jenny E Kootstra-Ros; Jan Stephan F Sanders; Stefan P Berger; Juan Jesus Carrero; Martin H De Borst; Gerjan J Navis; Stephan J L Bakker Journal: Clin J Am Soc Nephrol Date: 2021-06-16 Impact factor: 10.614