Study Reveals Concerns Over High Protein Intake in Elderly Patients With CKD

A majority of elderly patients with chronic kidney disease (CKD) are spontaneously on diets consisting of a higher-than-recommended amount of protein intake, suggesting that there is a need for nutritional care for this population of patients with CKD, according to a recent study.

The observational study, published in Nutrients­, attempted to fill the knowledge gap regarding the dietary habits, particularly in regard to protein intake, of elderly patients with CKD referred to a dedicated large outpatient unit in a large public hospital in France.

“These data are precious to tailor nutritional approaches and educational interventions, and thereby contribute to answering open questions regarding the need for nutritional care, with specific regard to protein intake, in elderly CKD patients,” the investigators wrote.

Recent guidelines from the Kidney Disease Outcomes Quality Initiative (KDOQI) on nutritional management in patients with CKD were expanded to include protein restriction as a way to decrease mortality and morbidity; however, it is not widely practiced. Although data on the diffusion of prescription of protein restriction in the elderly CKD population are lacking, there are concerns that elderly patients may be more reluctant to change their dietary habits.

“Filling the current gap of knowledge on what is the actual protein intake in different populations of elderly CKD patients referred to nephrology care may help understand the actual need for nutritional management, and help to better define the clinical and educational needs tailored to this fragile population,” the investigators said.

Between November 13, 2017, and December 31, 2020, the investigators collected data on 436 patients with CKD stages 3,4, or 5 who were not on dialysis therapy from the Centre Hospitalier Le Mans in Central France. The cohort consisted of 59.2% men. The patients were divided in to 5 age groups:

• Young: Younger than 60 years (n = 62)
• Young-old: Between ages 60 and 69 years (n = 74)
• Old: Between ages 70 and 79 years (n = 106)
• Old-old: Between ages 80 and 89 years (n = 140)
• Oldest-old: 90 years or older (n = 54)

The prevalence of vascular nephropathies was observed to be higher in patients 70 years or older compared with younger patients, suggesting that most of the patients did not display relevant proteinuria.

Additionally, the prevalence of moderate nutritional impairment was higher in the young-old, old, old-old, and oldest-old groups compared with the young age group, reaching 53.7% in the oldest-old group. The Malnutrition-Inflammation scores were also greater in the age groups containing patients 60 years and older compared with the young age group.

The median protein intake was higher than the amount recommended by the KDOQI (0.8 g/kg of body weight per day) in all age groups. However, the median baseline protein intake decreased from 1.2 g/kg of body weight per day in patients in the young age group to 1.1 g/kg/day in the young-old group and to 1.0 g/kg/day in the older age groups. Patients older than 60 years had a significantly higher prevalence of cases with normal or spontaneously reduced protein intake compared with younger patients.

“Independently from referral biases, considering the recently published KDOQI guidelines on nutritional management in CKD patients, our study suggests that regardless of age and comorbidity, patients referred to a nephrology unit would benefit from nutritional assessment and probably also, at least in cases at higher risk for disease progression, from reduced protein intake,” noted the investigators.

The study limitations included a potential referral bias, the fact that nutritional assessment was performed in most but not all patients, and a lack of sufficient follow-up data.

Reference

Torreggiani M, Fois A, Moio MR, et al. 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. 2021;13:4371. doi:10.3390/nu13124371