Patients with CKD, with or without diabetes, had similar nutritional status

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Key takeaways:

  • Daily protein and energy intake were not vastly different in patients with CKD.
  • Patients with and without diabetes had low daily energy intake.

Diet and nutritional status of patients with stage 4 to 5 chronic kidney disease may not vastly differ between those with or without diabetes.

In an observational, cross-sectional study, researchers in the department of nephrology at the French Hospices Civils de Lyon observed patient-reported daily dietary intake, as well as urine samples, of 75 adults referred to a nephrology unit. Overall, 48% of the patients had diabetes. Bioimpedance analysis was used to assess body composition and handgrip strength to gauge muscle function, according to the study. A protein-energy wasting (PEW) score measured undernutrition.

Healthy diet

Daily protein and energy intake were not vastly different in patients with CKD. Image: Adobe Stock.

Researchers found daily protein intake (DPI) and daily energy intake (DEI) were not significantly different between patients with CKD with or without diabetes, but patients with diabetes consumed less calcium and fiber, had lower lean body mass and higher BMI.

“In the present cohort of patients with CKD stage 4 [to] 5, in which diabetic and non-diabetic patients had similar characteristics in terms of renal function, serum albumin and urinary parameters, the diabetic status per se was not independently associated with DPI nor DEI,” Mariana Cassani de Oliveira, MD, PhD, and colleagues, wrote.

The authors noted that both patients with and without diabetes had energy intake below recommendations, which is one of the risk factors for PEW.

“The proportion of patients with PEW was not significantly different between diabetic and nondiabetic patients,” though, according to the research. “In univariate analysis, diabetes was associated with weight-adjusted DPI … but this association did not remain significant in multivariate analysis. Nutritional status did not differ significantly between diabetic and nondiabetic patients except for lean tissue mass, which was lower in diabetic patients.”

The study had limits, including a small sample size and patient-reported dietary intakes that could include recall bias. The researchers called for larger multicenter studies that use longitudinal analysis. They noted periodic monitoring of dietary intake and nutritional status in patients with CKD and without diabetes is fundamental to verify compliance with guidelines, and avoid progression toward PEW, ESKD and other complications.

“Nutrition is a cornerstone of nephroprotection,” the researchers wrote. “Adequate energy and protein dietary intakes in CKD stage 4 [to] 5 are fundamental to maintain nutritional status and to slow the progression of the disease.”

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