Assessment of diet in chronic kidney disease female predialysis patients
More details
Hide details
Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
Nephrological Outpatient Clinic, Public Central Teaching Hospital (SPCSK), Warsaw, Poland
Dariusz Włodarek   

Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
Ann Agric Environ Med. 2014;21(4):829–834
Introduction and objective:
Nutrition is important in the therapy of predialysis patients. The aim of the presented single-centre descriptive study was to assess the diet in chronic kidney disease female predialysis patients with no previous dietary intervention, in comparison with recommendations, as well as the analysis of the energy, protein and phosphate intake in correlation with chosen laboratory measurements.

Material and Methods:
The research was carried out in 31 female predialysis patients with CKD of different etiology, aged 29–79 years (GFR: 19.4±9.7ml/min/1.73m2). Main outcome measures were self-reported data from three-day dietary recall. Nutrients content and energy value of diet were compared with guidelines for chronic kidney disease patients or, in case of nutrients when they are not settled, with the recommendations for healthy women.

All patients had a lower energy intake than the recommended level. At the same time, 35.8% of patients were characterised by improper protein intake – too low or too high. The majority of patients had low intake of most of vitamins and minerals. The total, animal and plant protein were positively correlated with the energy value of diet and with amount of most of the nutrients. Values of GFR were positively correlated with animal protein intake, while phosphate and creatinine in blood were negatively correlated with total and animal protein intake.

The study highlights that diet of CKD predialysis patients with no previous dietary intervention is not properly balanced.

Ayli MD, Ayli M, Ensari C, Mandiroglu F, Allioglu M. Effect of low-protein diet supplemented with keto acids on progression of disease in patients with chronic renal failure. Nephron. 2000; 84: 288–289.
Inaguma D, Tatematsu M, Shinjo H, Suzuki S, Mishima T, Inaba S, et al. Effect of an educational program on the predialysis period for patients with chronic renal failure. Clin Exp Nephrol. 2006; 10: 274–278.
Halpin D, Stevens P, Bakhshi L, Benett I, Crowe E, Dodwell M, et al. Chronic kidney disease. National clinical guideline for early identification and management in adults in primary and secondary care. Lavenham Press. London: Royal College of Physicans, 2008.
Steiber AL. Clinical indicators associated with poor oral intake of patients with chronic renal failure. J Ren Nutr. 1999; 9: 84–88.
Duenhas MR, Draibe SA, Avesani CM, Sesso R, Cuppari L. Influence of renal function on spontaneous dietary intake and on nutritional status of chronic renal insufficiency patients. Eur J Clin Nutr. 2003; 57: 1473–1478.
WHO. Protein and amino acid requirements in human nutrition. Report of a Joint WHO/ FAO/ UNU Expert Consultation 2002. World Health Organisation. Geneva: United Nations University, 2007.
Jarosz M, Bułhak-Jachymczyk B [ed.]. Human Nutrition Recommendations (in polish). Wydawnictwo Lekarskie PZWL, Warsaw 2008.
NKF K/DOQI. Nutrition in chronic renal failure. Am J Kidney Dis. 2000; 35(Suppl 2).
Czekalski S, Rutkowski B, Chrzanowski W, Ciechanowski K, Klinger M, Książek A, et al. Recommendations of the Board of the Polish Nephrology Consultant’s Working Group for the conservative treatment in chronic renal failure (in polish). Board of the Polish Nephrology Consultant’s Working Group, Warsaw, 2004.
Chaveau P, Aparicio M. Benefits in nutritional interventions in patients with CKD stage 3–4. J Ren Nutr. 2011; 21: 20–22.
Maroni BJ. Protein restriction in the pre-end-stage renal disease (ESRD) patient: who, when, how, and the effect on subsequent ESRD outcome. J Am Soc Nephrol. 1998; 9 (Suppl): S100-S106.
Robertson L, Waugh N, Robertson A. Protein restriction for diabetic renal disease. Cochrane Database of Systematic Reviews 2007; 4: CD002181.
Kopple JD. Pathophysiology of protein-energy wasting in chronic renal failure. J Nutr. 1999; 129(Suppl 1): 247–251.
Lezaic V, Tirmenstajn-Jankovic B, Bukvic D, Vujisic B, Perovic M, Novakovic N, et al. Efficacy of hyperphosphatemia control in the progression of chronic renal failure and the prevalence of cardiovascular calcification. Clin Nephrol. 2009; 71: 21–29.
Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006; 145: 247–254.
Hebert I, Ockene IS, Hurley TG, Luippold R, Well AD, Harmatz MG. Development and testing of a seven-day dietary recall. J Clin Epidemiol. 1997; 50: 925–937.
Kunachowicz H, Nadolna I, Kłys W, Iwanow K, Kruszewska B. Gluten-free products composition and nutritive value. National Food and Nutrition Institute, Warsaw, 1995.
Kunachowicz H, Nadolna J, Przygoda B, Iwanow K. Food Composition Tables. Wydawnictwo Lekarskie PZWL, Warsaw, 2005.
NKF K/DOQI. Clinical practice guidelines for managing dyslipidemias in chronic kidney disease. Am J Kidney Dis. 2003; 41 (Suppl 3).
Nowicki M, Czekalski S, Rutkowski B, Bidas K, Chrzanowski W, Grzegorzewska A, et al. Recommendations of the Board of the Polish Nephrology Consultant’s Working Group for the diagnosis and treatment of disturbances of calcium – phosphate metabolism in patent with chronic renal failure (in polish). Board of the Polish Nephrology Consultant’s Working Group, Warsaw, 2004.
EDTNA/ ERCA. European guidelines for the nutritional care of adult renal patients. European Dialysis and Transplantation Nurses Association/ European Renal Care Association, Dietitians Special Interest Group, 2002.
Jansen MA, Korevaar JC, Dekker FW, Jager KJ, Boeschoten EW, Krediet RT. Renal function and nutritional status at the start of chronic dialysis treatment. J Am Soc Nephrol. 2001; 12: 157–163.
López EP, Rice C, Weddle DO, Rahill GJ. The relationship among cardiovascular risk factors, diet patterns, alcohol consumption, and ethnicity among women aged 50 years and older. J Am Diet Assoc. 2008; 108: 248–256.
Beto JA, Bansal VK. Medical nutrition therapy in chronic kidney failure: Integrating Clinical Practice Guidelines. J Am Diet Assoc. 2004; 104: 404–409.
Iseki K, Shinzato T, Nagura Y, Akiba T. Factors influencing long-term survival in patients on chronic dialysis. Clin Experim Nephrol. 2004; 8: 89–97.
Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB. Survival advantages of obesity in dialysis patients. Am J Clin Nutr. 2005; 81: 543–554.
Herselman M, Esau N, Kruger JM, Labadarios D, Moosa MR. Relationship between body mass index and mortality in adults on maintenance hemodialysis: a systematic review. J Ren Nutr. 2010; 20: 281–292.
Beddhu S, Pappas LM, Ramkumar N, Samore M. Effects of body size and body composition on survival in hemodialysis patients. J Am Soc Nephrol. 2003; 14: 2366–2372.
Kopple JD, Greene T, Chumlea WC, Hollinger D, Maroni BJ, Merrill D, et al. Relationship between nutritional status and the glomerular filtration rate: Results from the MDRD Study. Kidney Int. 2000; 57: 1688–1703.
Passey C, Bunker V, Jackson A, Lee H. Energy balance in predialysis patients on a low-protein diet. J Ren Nutr. 2003; 13: 120–125.
Huang MC, Chen ME, Hung HC, Chen HC, Chang WT, Lee CH, et al. Inadequate energy and excess protein intakes may be associated with worsening renal function in chronic kidney disease. J Ren Nutr. 2008; 18: 187–194.
Meloni C, Morosetti M, Suraci C, Pennafina MG, Tozzo C, Taccone-Gallucci M, et al. Severe dietary protein restriction in overt diabetic nephropathy: benefits or risks? J Ren Nutr. 2002; 12: 96–101.
Ideura T, Shimazui M, Higuchi K, Morita H, Yoshimura A. Effect of nonsupplemented low-protein diet on very late stage CRF. Am J Kidney Dis. 2003; 41 (Suppl 1): S31-S34.
Murray RK, Granner DK, Mayes PA, Rodwell VW. Harper’s biochemistry, McGraw-Hill Health Professions Division. New York, 2002.
Martin WF, Armstrong LE, Rodriguez NR. Dietary protein intake and renal function. Nutr Metab. 2005; 2: 25–33.
Lim VS, Kopple JD. Protein metabolism in patients with chronic renal failure: Role of uremia and dialysis. Kidney Int. 2000; 58: 1–10.
Riabov SI, Kucher AG, Grigor’eva ND, Kaiukov IG, Ermakov IA. Effects of different variants of low-protein diet on progression of chronic renal failure and indices of nutritional status in predialysis stage. Ter Arkh. 2001; 73: 10–15.
Fishbane S, Nissenson AR. Anaemia management in chronic kidney disease. Kidney Int. 2010; 78: S3-S9.
Taskapan H, Wei M, Oreopoulos DG. 25(OH) Vitamin D 3 in patients with chronic kidney disease and those on dialysis: rediscovering its importance. Int Urol Nephrol. 2006; 38: 323–329.
Carter JL, O’Riordan SE, Eaglestone GL, Delaney MP, Lamb EJ. Bone mineral metabolism and its relationship to kidney disease in a residential care home population: a cross-sectional study. Nephrol Dial Transplant. 2008; 23: 3554–3565.
Mann JFE, Sheridan P, McQueen MJ, Held C, Arnold JM, Fodor G, et al. Homocysteine lowering with folic acid and B vitamins in people with chronic kidney disease – results of the renal Hope-2 study. Nephrol Dial Transplant. 2008; 23: 645–653.
Menon V, Wang X, Greene T, Beck GJ, Kusek JW, Selhub J, et al. Homocysteine in chronic kidney disease: Effect of low protein diet and repletion with B vitamins. Kidney Int. 2005; 67: 1539–1546.
Faeh D, Chiolero A, Paccaud F. Homocysteine as a risk factor for cardiovascular disease: should we (still) worry about? Swiss. Med. Wkly. 2006; 136: 745–756.
Cliffe M, Bloodworth LL, Jibani MM. Can malnutrition in predialysis patients be prevented by dietetic intervention? J Ren Nutr. 2001; 11: 161–165.
Milovanov IS, Kozlovskaia LV, Milovanova LI. Nephroprotective role of early correction of impaired nutritional status in patients with chronic disease of the kidneys at a predialysis stage. Ter Arkh. 2008; 80: 29–33.
Karalis M. Low protein products. J Ren Nutr. 2003; 13: 1–3.
Cupisti A, D’Alessandro C, Morelli E, Rizza GM, Galetta F, Franzoni F, et al. Nutritional status and dietary manipulation in predialysis chronic renal failure patients. J Ren Nutr. 2004; 14: 127–133.